Drobniak-Hełdak Dominika, Kolasińska-Kloch Władysława, Rajtar-Salwa Renata
II Klinika Kardiologii, Instytut Kardiologii, Collegium Medicum Uniwersytetu Jagiellońskiego, Kraków.
Folia Med Cracov. 2009;50(3-4):43-54.
Acute coronary syndrome as unstable angina and myocardial infarction are the clinical manifestations of destabilization of coronary atherosclerotic plaques. Optimal medical treatment (OMT) in addition to percutaneous transluminal coronary angioplasty (PTCA) with stent implantation decreased risk of cardiovascular mortality. This study was undertaken for searching the new cardiac risk factors to assess the clinical outcome in patients with acute myocardial infarct and stable angina receiving PTCA with stent implantation. The study included a sort group of 68 men, 26 with acute myocardial infarct (AMI), 29 with stable angina (SA) and 13 healthy men (K). Patients were treated with transluminal coronary angioplasty with stent implantation and continued standard pharmacological treatment. Measurements were taken at admission (baseline) and at 7 and 28 days (post-stress) after successful PTCA. Levels of IMA/ALB, hsCRP, CK, CK-MB, Troponin I, albumin, antioxidant potency parameters (FRAP, SH) and oxidative stress parameters (LOOH, IMA) were analyzed in serum from all patients. Our study demonstrated significantly higher serum IMA/ALB ratio in AMI group in comparison to SA group and controls. Categorized histogram revealed the highest IMA frequency in patients with angiographically confirmed stenosis compared to examined control subjects. IMA value tended to decrease in post-stress period but still remained the highest in AMI group as compared to controls. IMA concentrations were inversely correlated with heart ejection fraction, plasma antioxidant potential parameters (FRAP, SH) and positively correlated with CK and CKMB values. The comparative 1 year outcomes documented clinical failure in 19% vs. 52% of patients in AMI and SA groups respectively. The overweight and low antioxidant potency reached the statistical significance relevant to restenosis and cardiovascular events in SA group. Our data suggest that IMA levels in the course of myocardial ischemia treatment by PTCA may be useful as a discriminating marker for definition of the high risk group of patients with suspected cardiovascular complications.
急性冠状动脉综合征如不稳定型心绞痛和心肌梗死是冠状动脉粥样硬化斑块不稳定的临床表现。除经皮冠状动脉腔内血管成形术（PTCA）及支架植入术外，优化药物治疗（OMT）可降低心血管死亡率。本研究旨在寻找新的心脏危险因素，以评估接受PTCA及支架植入术的急性心肌梗死和稳定型心绞痛患者的临床结局。该研究纳入了一组68名男性，其中26例为急性心肌梗死（AMI）患者，29例为稳定型心绞痛（SA）患者，13例为健康男性（K）。患者接受了冠状动脉腔内血管成形术及支架植入术，并继续进行标准药物治疗。在入院时（基线）以及成功PTCA术后7天和28天（应激后）进行测量。分析了所有患者血清中的IMA/ALB、高敏C反应蛋白（hsCRP）、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、肌钙蛋白I、白蛋白、抗氧化能力参数（FRAP、SH）和氧化应激参数（LOOH、IMA）水平。我们的研究表明，与SA组和对照组相比，AMI组血清IMA/ALB比值显著更高。分类直方图显示，与检查的对照受试者相比，血管造影证实有狭窄的患者中IMA频率最高。IMA值在应激后时期趋于下降，但与对照组相比，在AMI组中仍保持最高。IMA浓度与心脏射血分数、血浆抗氧化能力参数（FRAP、SH）呈负相关，与CK和CKMB值呈正相关。1年的比较结果显示，AMI组和SA组患者的临床失败率分别为19%和52%。超重和抗氧化能力低与SA组的再狭窄和心血管事件具有统计学意义的相关性。我们的数据表明，在PTCA治疗心肌缺血过程中，IMA水平可能作为定义疑似心血管并发症高危患者组的鉴别标志物。
