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475 THE IMPACT OF PERCUTANEOUS CORONARY INTERVENTION (PCI) WITH STENT IMPLANTATION UPON MMP9 AND INFLAMATORY MARKERS IN PATIENTS WITH ACUTE CORONARY SYNDROMES
79th EAS Congress
Atherosclerosis Supplements 12, no. 1 (2011) 13–184
ecto adenylate kinase, ATP released and sP-selectin were characteristic of increased metabolic activity in cardiomiocytes. The high level TnI accompanied by low concentrations of released ATP, which confirms the degree of myocardial damage. 472 ENDOTHELIAL DERIVATIVES AS THE POSSIBLE PREDICTORS OF THE CARDIOVASCULAR RISK IN RHEUMATOID ARTHRITIS PATIENTS (RA) WITH HYPERCHOLESTEROLEMIA R. Rupinski, E. Walewska, A. Filipowicz-Sosnowska, P. Gluszko. Department of Rheumatology, Institute of Rheumatology, Warsaw, Poland Introduction: The HeartScore (SCORE) assessment tool is used to predict relative risk of serious atherosclerotic cardiovascular (CV) events. RA patients are at even higher risk of CV diseases. Objective: To assess correlation of the SCORE estimated CV risk with serum levels of endothelial adhesion molecules and other vascular derivatives in RA patients with cholesterol concentration >200 mg/dl. Methods: Clinical and metabolic (BMI, atherogenicity index − AI) profile was evaluated in the group of 72 RA patients (93% female, age 42−74 years). Serum concentrations of intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), vascular endothelial growth factor (VEGF) and E-selectin were measured using ELISA. Results: The mean values (±SD) in the study group were: age − 58.6 years (7.6), disease duration − 9.2 years (8.6), CRP − 10.5 mg/l (7.5), BMI − 26.9 (4.3), AI − 4.16 (1.31), ICAM-1–4887 pg/ml (515), VCAM-1–326 pg/ml (77), VEGF − 134 pg/ml (133) and E-selectin − 6965 pg/ml (1965). The mean SCORE value (±SD) for the whole RA group was 4.64 (3.84) and 32% patients exceeded the 5% threshold for high CV risk. The correlations between VEGF and SCORE values (r = 0.25, p < 0.037), E-selectin and the cholesterol component of SCORE (r = −0.34, p = 0.021) were found. Other correlations including CRP, BMI and AI were statistically insignificant. Conclusions: We found association between elevated VEGF levels and higher risk of CV events in RA. Interestingly, E-selectin negatively correlated with the cholesterol component of SCORE. 473 BACK TO THE FUTURE IN TREATMENT OF REFRACTORY NO-REFLOW AFTER PRIMARY PERCUTANEOUS CORONARY INTERVENTION: INTRACORONARY EPINEPHRINE T. Aksu, A. Colak, M. Durukan, U. Guray, H. Kısacık. Turkiye Yuksek Ihtisas Education and Investigation Hospital, Ankara, Turkey Background: The goal of this study was to evaluate the safety and efficacy of intracoronary epinephrine in reversing refractory no-reflow during percutaneous coronary intervention (PCI). Methods: We retrospectively evaluated 12 consecutive patients who received intracoronary epinephrine to reverse refractory no-reflow during primary PCI. The effects of intracoronary epinephrine on qualitative TIMI flow grade and quantitative TIMI frame count, cardiac rhythm, and systolic blood pressure were assessed. Results: A mean of 333±123 mcg of intracoronary epinephrine was used. No-reflow was successfully reversed with complete restoration of TIMI 3 flow in 9 of 12 patients (75%). TIMI flow grade improved from 1.33±0.49 prior to epinephrine to 2.66±0.65 after treatment (p < 0.001). There was improvement in coronary flow of at least one TIMI flow grade in 11 (93%) patients, two flow grades in 5 (42%) cases. TIMI frame count decreased from 56±10 at the time of no-reflow to 19±11 (p < 0.001). Epinephrine therapy was well tolerated without serious adverse hemodynamic or chronotropic effects. Intracoronary epinephrine resulted in significant but tolerable increase in heart rate (68±13 to 95±16 beats/min; p < 0.001) and systolic blood pressure (94±18 to 140±20; p < 0.001). Hypotension associated with no-reflow developed in 5 (42%) patients. During the procedure, intra-aortic balloon pump counterpulsation was required in two (17%) patients, transvenous pacing in 2 (17%) cases, and both intra-aortic balloon counterpulsation and transvenous pacing in one (8%) patients. One patient 3.4% died despite therapeutic measures. Conclusion: Intracoronary epinephrine may become an effective alternative in patients suffering refractory no-reflow following primary PCI. 474 EFFECT OF QUERCETIN ON THE DYNAMICS OF THE LEVEL OF NT-PROBNP IN PATIENTS WITH ACUTE CORONARY SYNDROME A. Alavy Lutfullaevich1 , S. Varisxanova2 , S. Kenjaev1,2 . 1 Urgent Cardiology, Republican Research Center of Emergency Medicine, 2 Republican Research Center of Therapy and Medical Rehabilitation, Tashkent, Uzbekistan Aim: To study of the concentration of NT-pro BNP in acute coronary syndrome (ACS+ST) with ST elevation after intravenous infusion of quercetin. Methods: The study included 68 patients with ACS+ST (age 57.62±4.64 y). All patients underwent reperfusion therapy. The 1st group (n = 31) patients received basic therapy. The 2nd group (n = 37) patients who also received the antioxidant drug quercetin (Corvitin, Ukraine) by intravenous infusion at a dose of 1500– 1000 gr/day immediately after admission in hospital, after 2 and 12 hours for
101
2−3 days. All patients at baseline, at the 3rd and 5-th day was determined concentration NT-proBNP. Reliability of intergroup differences was calculated using Student’s t test. Results: Patients in 1st group showed a significant increase in the concentration of NT-proBNP to the 3rd day of observation at 52.78% with subsequent decrease in 32.29% of the baseline, but in the 2 nd group the peak concentration of NT-pro BNP to the 3-th day was absent, and there was a progressive decline of 23.52% and 60.21%, respectively, to the 3rd and 5th days (difference in the dynamics of concentration of NT-pro BNP throughout the observation period − p < 0.001). As a result, and the third at 5-day concentration of NT-pro BNP in patients taking Corvitin was significantly lower than patients receiving only basic therapy (p < 0.001 for 3rd and 5th days of observation). Conclusion: Inclusion of quercetin in the treatment of ACS+ST contributes to the gradual decrease in the concentration of NT-proBNP and the disappearance of the peak on the 3rd day. 475 THE IMPACT OF PERCUTANEOUS CORONARY INTERVENTION (PCI) WITH STENT IMPLANTATION UPON MMP9 AND INFLAMATORY MARKERS IN PATIENTS WITH ACUTE CORONARY SYNDROMES F. Revnic1 , C.R. Revnic2 , C. Ginghina3 , A. Mereuta4 , D. Gradinaru5 , G. Prada6 , S. Prada7 , C. Pena8 , C. Borsa9 , C. Ionescu9 . 1 Biology of Aging, NIGG’ANA ASLAN’, 2 Cardiology, UMF Carol Davila, 3 Cardiology, 4 Interventional Cardiology, C.C.Iliescu Cardiovascular Institute, 5 Pharmachology, 6 Gerontology and Geriatrics, UMF Carol Davila, 7 Pharmacy, 8 Imunology, 9 Biochemistry, NIGG’ANA ASLAN’, Bucharest, Romania The aim of this study was to evaluate if serum levels of matrix metalloproteinase-9 (MMP-9), IL6, IL8, hsCRP and NOx are associated with development of ISR after stent implantation. We performed PCI with a single stent in 80 patients (50 with BMS and 30 with DES (58±8 years old)who had acute coronary syndrome. Serum levels from of MMP-9, IL6, and hsCRP activity were measured by specific ELISA and NOx levels using a Nitrite/Nitrate assay before stent implantation and at 24 hours. Patients with ISR at followˆ up showed significantly higher MMP-9 activity levels at baseline (34A±15 vs. ˆ ˆ ˆ 23A±10 ng/mL; p < 0.01) and 24 hours after PCI (53A±28 vs. 26A±12 ng/mL). IL-6 0.46±0.03 ng/L versus 0.40±0.07 ng/Patients in the highest quartile before and after PCI showed a 6.5 (1.7−26) and 7.7 (18.2.1−35)-fold risk for the development of restenosis, respectively. Plasma hsCRP levels at 24h (10.12±3.55 vs 6.43±1.63, P = 0.001) after stent implantation were significantly higher in the BMS group than in the DES. The level of NOx at base line was 46.94±8.5umol/L and 103.98umol/l after 24 h PCI and stent implantation The occurrence of ISR was significantly associated with MMP-9 activity and NOx before and after placement of BMS. As MMP-9, Nox, hsCRP and IL6 may play a role in the pathogenesis of ISR, determination of hsCRP and MMP-9, Nox and IL6 serum levels might be helpful in the identification of patients with high risk for development of ISR after DES implantation. 476 ACUTE CORONARY SYNDROME AND LOW-HDL CHOLESTEROL. RELATIONSHIP WITH LIPOPROTEIN (A) R. Toro1 , P. Gomez1 , C. Rodriguez1 , I. Tinoco1 , D. Biedma1 , M. Virseda1 , A. Mangas2 . 1 Cadiz University, 2 Medicine, Cadiz University, Cadiz, Spain Several studies have shown that a high serum level of lipoprotein (a), lp(a), may be an independent risk factor for atherotrombotic disease including myocardial infarction. Metabolic syndrome (MS), a clustering of cardiovascular risk factors, including low HDL-C concentration, is linked with an increased risk of developing cardiovascular disease and diabetes mellitus. Aim: Was to know the prevalence of MS and low-HDL-c syndrome in patients with acute coronary syndrome (ACS) and relationship with serum lp(a). Material and Methods: We examined 65 ACS patients (50 males) with 64.5 y-o. Blood analysis and lipid profile were done before the sixth day of the hospital stay. Low HDL-c was defined as a serum concentration <1.04 mmol/l in men and <1.3 mmol/l in women. Results: Low HDL-c was observed in 42 (64.6%) patients. 44 (67.7%). MS was diagnosed using NCEP ATP III criteria. In 25 patients (19 males, 38%) low HDL-c syndrome is associated with MS. Lp(a) revealed significant elevation in ACS. We did not found significance differences neither in patients with MS nor low HDL-c syndrome. Conclusions: Spanish patients with ACS had a very high prevalence of low HDL-c syndrome and MS. Lp(a) is an emerging risk factor potentially useful predicting future cardiac events. We found lp (a) serum concentration elevated in ACS. Increased lp(a) were not associated with SM nor low HDL-c in ACS. 477 IP-10 AND ACUTE MYOCARDIAL INFARCTION A.E. Nadimi. Rafsanjan University of Medical Science, Rafsanjan, Iran Background: Cardiovascular disease are the most common cause of death in the world and also in Iran. IP-10 “angiostatic chemokine” is an effective chemokine for decreasing inflammation and injury. This study evaluated and
Atherosclerosis Supplements 12, no. 1 (2011) 13–184
ecto adenylate kinase, ATP released and sP-selectin were characteristic of increased metabolic activity in cardiomiocytes. The high level TnI accompanied by low concentrations of released ATP, which confirms the degree of myocardial damage. 472 ENDOTHELIAL DERIVATIVES AS THE POSSIBLE PREDICTORS OF THE CARDIOVASCULAR RISK IN RHEUMATOID ARTHRITIS PATIENTS (RA) WITH HYPERCHOLESTEROLEMIA R. Rupinski, E. Walewska, A. Filipowicz-Sosnowska, P. Gluszko. Department of Rheumatology, Institute of Rheumatology, Warsaw, Poland Introduction: The HeartScore (SCORE) assessment tool is used to predict relative risk of serious atherosclerotic cardiovascular (CV) events. RA patients are at even higher risk of CV diseases. Objective: To assess correlation of the SCORE estimated CV risk with serum levels of endothelial adhesion molecules and other vascular derivatives in RA patients with cholesterol concentration >200 mg/dl. Methods: Clinical and metabolic (BMI, atherogenicity index − AI) profile was evaluated in the group of 72 RA patients (93% female, age 42−74 years). Serum concentrations of intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), vascular endothelial growth factor (VEGF) and E-selectin were measured using ELISA. Results: The mean values (±SD) in the study group were: age − 58.6 years (7.6), disease duration − 9.2 years (8.6), CRP − 10.5 mg/l (7.5), BMI − 26.9 (4.3), AI − 4.16 (1.31), ICAM-1–4887 pg/ml (515), VCAM-1–326 pg/ml (77), VEGF − 134 pg/ml (133) and E-selectin − 6965 pg/ml (1965). The mean SCORE value (±SD) for the whole RA group was 4.64 (3.84) and 32% patients exceeded the 5% threshold for high CV risk. The correlations between VEGF and SCORE values (r = 0.25, p < 0.037), E-selectin and the cholesterol component of SCORE (r = −0.34, p = 0.021) were found. Other correlations including CRP, BMI and AI were statistically insignificant. Conclusions: We found association between elevated VEGF levels and higher risk of CV events in RA. Interestingly, E-selectin negatively correlated with the cholesterol component of SCORE. 473 BACK TO THE FUTURE IN TREATMENT OF REFRACTORY NO-REFLOW AFTER PRIMARY PERCUTANEOUS CORONARY INTERVENTION: INTRACORONARY EPINEPHRINE T. Aksu, A. Colak, M. Durukan, U. Guray, H. Kısacık. Turkiye Yuksek Ihtisas Education and Investigation Hospital, Ankara, Turkey Background: The goal of this study was to evaluate the safety and efficacy of intracoronary epinephrine in reversing refractory no-reflow during percutaneous coronary intervention (PCI). Methods: We retrospectively evaluated 12 consecutive patients who received intracoronary epinephrine to reverse refractory no-reflow during primary PCI. The effects of intracoronary epinephrine on qualitative TIMI flow grade and quantitative TIMI frame count, cardiac rhythm, and systolic blood pressure were assessed. Results: A mean of 333±123 mcg of intracoronary epinephrine was used. No-reflow was successfully reversed with complete restoration of TIMI 3 flow in 9 of 12 patients (75%). TIMI flow grade improved from 1.33±0.49 prior to epinephrine to 2.66±0.65 after treatment (p < 0.001). There was improvement in coronary flow of at least one TIMI flow grade in 11 (93%) patients, two flow grades in 5 (42%) cases. TIMI frame count decreased from 56±10 at the time of no-reflow to 19±11 (p < 0.001). Epinephrine therapy was well tolerated without serious adverse hemodynamic or chronotropic effects. Intracoronary epinephrine resulted in significant but tolerable increase in heart rate (68±13 to 95±16 beats/min; p < 0.001) and systolic blood pressure (94±18 to 140±20; p < 0.001). Hypotension associated with no-reflow developed in 5 (42%) patients. During the procedure, intra-aortic balloon pump counterpulsation was required in two (17%) patients, transvenous pacing in 2 (17%) cases, and both intra-aortic balloon counterpulsation and transvenous pacing in one (8%) patients. One patient 3.4% died despite therapeutic measures. Conclusion: Intracoronary epinephrine may become an effective alternative in patients suffering refractory no-reflow following primary PCI. 474 EFFECT OF QUERCETIN ON THE DYNAMICS OF THE LEVEL OF NT-PROBNP IN PATIENTS WITH ACUTE CORONARY SYNDROME A. Alavy Lutfullaevich1 , S. Varisxanova2 , S. Kenjaev1,2 . 1 Urgent Cardiology, Republican Research Center of Emergency Medicine, 2 Republican Research Center of Therapy and Medical Rehabilitation, Tashkent, Uzbekistan Aim: To study of the concentration of NT-pro BNP in acute coronary syndrome (ACS+ST) with ST elevation after intravenous infusion of quercetin. Methods: The study included 68 patients with ACS+ST (age 57.62±4.64 y). All patients underwent reperfusion therapy. The 1st group (n = 31) patients received basic therapy. The 2nd group (n = 37) patients who also received the antioxidant drug quercetin (Corvitin, Ukraine) by intravenous infusion at a dose of 1500– 1000 gr/day immediately after admission in hospital, after 2 and 12 hours for
101
2−3 days. All patients at baseline, at the 3rd and 5-th day was determined concentration NT-proBNP. Reliability of intergroup differences was calculated using Student’s t test. Results: Patients in 1st group showed a significant increase in the concentration of NT-proBNP to the 3rd day of observation at 52.78% with subsequent decrease in 32.29% of the baseline, but in the 2 nd group the peak concentration of NT-pro BNP to the 3-th day was absent, and there was a progressive decline of 23.52% and 60.21%, respectively, to the 3rd and 5th days (difference in the dynamics of concentration of NT-pro BNP throughout the observation period − p < 0.001). As a result, and the third at 5-day concentration of NT-pro BNP in patients taking Corvitin was significantly lower than patients receiving only basic therapy (p < 0.001 for 3rd and 5th days of observation). Conclusion: Inclusion of quercetin in the treatment of ACS+ST contributes to the gradual decrease in the concentration of NT-proBNP and the disappearance of the peak on the 3rd day. 475 THE IMPACT OF PERCUTANEOUS CORONARY INTERVENTION (PCI) WITH STENT IMPLANTATION UPON MMP9 AND INFLAMATORY MARKERS IN PATIENTS WITH ACUTE CORONARY SYNDROMES F. Revnic1 , C.R. Revnic2 , C. Ginghina3 , A. Mereuta4 , D. Gradinaru5 , G. Prada6 , S. Prada7 , C. Pena8 , C. Borsa9 , C. Ionescu9 . 1 Biology of Aging, NIGG’ANA ASLAN’, 2 Cardiology, UMF Carol Davila, 3 Cardiology, 4 Interventional Cardiology, C.C.Iliescu Cardiovascular Institute, 5 Pharmachology, 6 Gerontology and Geriatrics, UMF Carol Davila, 7 Pharmacy, 8 Imunology, 9 Biochemistry, NIGG’ANA ASLAN’, Bucharest, Romania The aim of this study was to evaluate if serum levels of matrix metalloproteinase-9 (MMP-9), IL6, IL8, hsCRP and NOx are associated with development of ISR after stent implantation. We performed PCI with a single stent in 80 patients (50 with BMS and 30 with DES (58±8 years old)who had acute coronary syndrome. Serum levels from of MMP-9, IL6, and hsCRP activity were measured by specific ELISA and NOx levels using a Nitrite/Nitrate assay before stent implantation and at 24 hours. Patients with ISR at followˆ up showed significantly higher MMP-9 activity levels at baseline (34A±15 vs. ˆ ˆ ˆ 23A±10 ng/mL; p < 0.01) and 24 hours after PCI (53A±28 vs. 26A±12 ng/mL). IL-6 0.46±0.03 ng/L versus 0.40±0.07 ng/Patients in the highest quartile before and after PCI showed a 6.5 (1.7−26) and 7.7 (18.2.1−35)-fold risk for the development of restenosis, respectively. Plasma hsCRP levels at 24h (10.12±3.55 vs 6.43±1.63, P = 0.001) after stent implantation were significantly higher in the BMS group than in the DES. The level of NOx at base line was 46.94±8.5umol/L and 103.98umol/l after 24 h PCI and stent implantation The occurrence of ISR was significantly associated with MMP-9 activity and NOx before and after placement of BMS. As MMP-9, Nox, hsCRP and IL6 may play a role in the pathogenesis of ISR, determination of hsCRP and MMP-9, Nox and IL6 serum levels might be helpful in the identification of patients with high risk for development of ISR after DES implantation. 476 ACUTE CORONARY SYNDROME AND LOW-HDL CHOLESTEROL. RELATIONSHIP WITH LIPOPROTEIN (A) R. Toro1 , P. Gomez1 , C. Rodriguez1 , I. Tinoco1 , D. Biedma1 , M. Virseda1 , A. Mangas2 . 1 Cadiz University, 2 Medicine, Cadiz University, Cadiz, Spain Several studies have shown that a high serum level of lipoprotein (a), lp(a), may be an independent risk factor for atherotrombotic disease including myocardial infarction. Metabolic syndrome (MS), a clustering of cardiovascular risk factors, including low HDL-C concentration, is linked with an increased risk of developing cardiovascular disease and diabetes mellitus. Aim: Was to know the prevalence of MS and low-HDL-c syndrome in patients with acute coronary syndrome (ACS) and relationship with serum lp(a). Material and Methods: We examined 65 ACS patients (50 males) with 64.5 y-o. Blood analysis and lipid profile were done before the sixth day of the hospital stay. Low HDL-c was defined as a serum concentration <1.04 mmol/l in men and <1.3 mmol/l in women. Results: Low HDL-c was observed in 42 (64.6%) patients. 44 (67.7%). MS was diagnosed using NCEP ATP III criteria. In 25 patients (19 males, 38%) low HDL-c syndrome is associated with MS. Lp(a) revealed significant elevation in ACS. We did not found significance differences neither in patients with MS nor low HDL-c syndrome. Conclusions: Spanish patients with ACS had a very high prevalence of low HDL-c syndrome and MS. Lp(a) is an emerging risk factor potentially useful predicting future cardiac events. We found lp (a) serum concentration elevated in ACS. Increased lp(a) were not associated with SM nor low HDL-c in ACS. 477 IP-10 AND ACUTE MYOCARDIAL INFARCTION A.E. Nadimi. Rafsanjan University of Medical Science, Rafsanjan, Iran Background: Cardiovascular disease are the most common cause of death in the world and also in Iran. IP-10 “angiostatic chemokine” is an effective chemokine for decreasing inflammation and injury. This study evaluated and