Artha I Made Junior Rina, Bakta I Made, Manuaba Ida Bagus Putra, Wita I Wayan, Rohman Mohammad Saifur, Astawa I Nyoman Mantik, Bhargah Agha
Cardiology and Vascular Medicine Department, Faculty of Medicine, Universitas Udayana-Prof. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia.
Internal Medicine Department, Faculty of Medicine Universitas Udayana-Prof. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia.
Cardiol Res. 2023 Feb;14(1):69-78. doi: 10.14740/cr1455. Epub 2023 Feb 25.
Chronic total occlusion (CTO) is an angiographic picture of total occlusion without blood flow which is estimated to have lasted at least 3 months. This study attempted to provide an overview of the levels of matrix metalloproteinase-9 (MMP-9), soluble suppression tumorigenicity 2 (sST2), and N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) as remodeling, inflammatory, and atherosclerotic markers, as well as changes in the angina severity in patients with CTO who underwent percutaneous coronary intervention (PCI) compared to those without PCI.
This study is a preliminary report with quasi-experimental design study with a pre-test and post-test approach to compare PCI's effect in CTO patients towards changes in MMP-9, sST2, NT-pro-BNP levels, and changes in the angina severity. Twenty subjects underwent PCI and 20 subjects with optimal medical therapy, who were then assessed at baseline and 8 weeks after intervention.
The results of this preliminary report showed that decreased MMP-9 (pre-test: 12.07 ± 1.27 ng/mL vs. post-test: 9.91 ± 5.19 ng/mL, P = 0.049), sST2 (pre-test: 37.65 ± 20.00 ng/mL vs. post-test: 29.74 ± 15.17 ng/mL, P = 0.026) and NT-pro-BNP (pre-test: 0.63 ± 0.23 ng/mL vs. post-test: 0.24 ± 0.10 ng/mL, P < 0.001) levels were found after 8 weeks of PCI compared to those without such intervention. The levels of NT-pro-BNP were lower in the PCI group (0.24 ± 0.10 ng/mL) than in the non-PCI group (0.56 ± 0.23 ng/mL; P < 0.001). Moreover, there was an improvement of angina severity in PCI group than without PCI (P < 0.039).
Although this preliminary report found a significant decrease in MMP-9, NT-pro-BNP, and sST2 levels in CTO patients who had undergone PCI compared to those without PCI, as well as improved angina severity in these patients, this study still has limitations. The number of samples was so small that similar studies with larger sample sizes or multicenter investigations are required to deliver more trustworthy and useful results. Nevertheless, we encourage this study as a preliminary baseline for further studies in the future.
慢性完全闭塞（CTO）是指血管造影显示完全闭塞且无血流，估计持续时间至少3个月。本研究旨在概述基质金属蛋白酶-9（MMP-9）、可溶性抑制肿瘤生长因子2（sST2）和N末端B型利钠肽原（NT-pro-BNP）作为重塑、炎症和动脉粥样硬化标志物的水平，以及接受经皮冠状动脉介入治疗（PCI）的CTO患者与未接受PCI的患者相比，心绞痛严重程度的变化。
本研究是一项采用准实验设计的初步报告，采用前测和后测方法来比较PCI对CTO患者MMP-9、sST2、NT-pro-BNP水平变化及心绞痛严重程度变化的影响。20名受试者接受了PCI，20名受试者接受了最佳药物治疗，然后在基线和干预后8周进行评估。
该初步报告结果显示，与未接受PCI的患者相比，接受PCI 8周后，MMP-9（前测：12.07±1.27 ng/mL vs.后测：9.91±5.19 ng/mL，P = 0.049）、sST2（前测：37.65±20.00 ng/mL vs.后测：29.74±15.17 ng/mL，P = 0.026）和NT-pro-BNP（前测：0.63±0.23 ng/mL vs.后测：0.24±0.10 ng/mL，P < 0.001）水平均下降。PCI组的NT-pro-BNP水平（0.24±0.10 ng/mL）低于非PCI组（0.56±0.23 ng/mL；P < 0.001）。此外，与未接受PCI的患者相比，PCI组的心绞痛严重程度有所改善（P < 0.039）。
尽管该初步报告发现，与未接受PCI的CTO患者相比，接受PCI的患者MMP-9、NT-pro-BNP和sST2水平显著降低，且心绞痛严重程度有所改善，但本研究仍存在局限性。样本数量过少，需要进行更大样本量的类似研究或多中心调查才能得出更可靠、更有用的结果。尽管如此，我们鼓励将本研究作为未来进一步研究的初步基线。
