Arican Ozluk Ozlem, Topal Dursun, Tenekecioglu Erhan, Peker Tezcan, Yilmaz Mustafa, Karaagac Kemal, Vatansever Fahriye, Boyraz Bedrettin, Aydın Omur
Department of Cardiology, Bursa Ihtisas Training And Research Hospital Bursa, Turkey.
Int J Clin Exp Med. 2015 Feb 15;8(2):2554-61. eCollection 2015.
Coronary artery disease (CAD) and its serious clinical form, ST segment elevated myocardial infarction (STEMI) has been the leader within the death causes around the world and in our country. In STEMI, the main objective is providing the myocardial reperfusion. In our study, it was aimed to investigate the predictive value of tenascin-C level for the degree of myocardial reperfusion in patients with STEMI.
In our study, 58 patients admitted to our hospital with acute anterior STEMI were included. All the patients had underwent primary percutaneous intervention for the single-vessel disease at left anterior descending coronary artery. After admission to coronary care unit tenascin-C levels were measured. Subjects were classified according to their myocardial blush grades (MBG); MBG 0, MBG 1 and MBG 2 were groupped as Group I, MBG 3 was groupped as Group II. The groups were compared according to their tenascin-C levels and other parameters.
Between group I (n = 31, mean age 55 ± 12.5) and group II (n = 27, mean ages 49.3 ± 11.1); tenascin-C, troponin I and CK-MB levels were significantly higher in group I compared to the group-II (P < 0.001; P < 0.001 and P < 0.05; respectively). In group I, left ventricular ejection fraction (LVEF) was significantly lower (P < 0.001), left ventricular end-diastolic volume and left ventricular end-systolic volume were significantly higher (P = 0.03) as compared to group II. In group I, ST-segment resolution at ECG was worse (P = 0.003). In correlation analyzes, tenascin-C was significantly positively correlated with troponin-I (r = 0.596; P < 0.001) and CRP (r = 0.615, P < 0.001). Tenascin-C was significantly negatively correlated with MBG, LVEF and ST-segment resolution (r = -0.626, P < 0.001, r = -0.411, P = 0.002 and r = -0.631; P < 0.001, respectively).
Based on our study, it can be estimated that in patients with high tenascin-C levels myocardial reperfusion was inadequate, even underwent successfull PCI. In this context, increased tenascin-C may help predict not only left ventricular remodelling and prognosis but also the effectiveness of primary PCI.
冠状动脉疾病（CAD）及其严重的临床形式，即ST段抬高型心肌梗死（STEMI），一直是全球及我国主要的死亡原因。在STEMI中，主要目标是实现心肌再灌注。在我们的研究中，旨在探讨腱生蛋白-C水平对STEMI患者心肌再灌注程度的预测价值。
我们的研究纳入了58例因急性前壁STEMI入院的患者。所有患者均接受了左前降支单支血管病变的直接经皮冠状动脉介入治疗。入住冠心病监护病房后测量腱生蛋白-C水平。根据心肌显影分级（MBG）对受试者进行分类；MBG 0、MBG 1和MBG 2组为I组，MBG 3组为II组。比较两组的腱生蛋白-C水平及其他参数。
I组（n = 31，平均年龄55±12.5）和II组（n = 27，平均年龄49.3±11.1）相比，I组的腱生蛋白-C、肌钙蛋白I和肌酸激酶同工酶（CK-MB）水平显著高于II组（分别为P < 0.001、P < 0.001和P < 0.05）。与II组相比，I组的左心室射血分数（LVEF）显著降低（P < 0.001），左心室舒张末期容积和左心室收缩末期容积显著升高（P = 0.03）。I组心电图ST段回落情况较差（P = 0.003）。相关性分析显示，腱生蛋白-C与肌钙蛋白-I显著正相关（r = 0.596；P < 0.001），与C反应蛋白（CRP）显著正相关（r = 0.615，P < 0.001）。腱生蛋白-C与MBG、LVEF和ST段回落显著负相关（分别为r = -0.626，P < 0.001；r = -0.411，P = 0.002；r = -0.631，P < 0.001）。
基于我们的研究，可以推测，腱生蛋白-C水平高的患者即使成功接受了PCI，心肌再灌注仍不充分。在此背景下，腱生蛋白-C升高不仅有助于预测左心室重构和预后，还能预测直接PCI的效果。
