calca-protein--human and Acute-Coronary-Syndrome

Inflammation plays an important role in the pathophysiology of acute coronary syndrome as well as in the process of atherosclerosis in general. At the moment of myocardial ischaemia, local and systemic inflammatory reaction is amplified; in ischaemic myocardium there is increased expression of proinflammatory cytokines, particularly interleukin-6, which mediates C reactive protein (CRP) production by hepatocytes. CRP activates the complement cascade and thereby contributes to the lysis and removal of damaged cardiomyocytes. Whereas in a healthy population CRP levels range from 1.2 to 2.0 mg / l, in patients with ACS the levels of CRP significantly increase with the peak of 2nd to 4th day from the onset of myocardial infarction. Peak CRP levels ranged from 20 to 250 mg / l in patients with STEMI treated conservatively, the median of peak of CRP levels was 79 mg/ l in patients with anterior wall STEMI treated with primary PCI. There is a recommendation of CRP evaluation within the early risk stratification of patients with ACS according to the current ESC guidelines. In patients with NSTEMI, CRP levels > 10 mg/ l are associated with increased longterm mortality. In patients with STEMI treated with primary PCI, CRP levels > 79 mg/ l could predict negative left ventricle remodelation. The predictive value of GRACE risk score was improved using CRP, levels > 22 mg/ l predicted worse prognosis in patients with either STEMI or NSTEMI treated invasively. However, if also cardiac troponin and natriuretic peptides in addition to GRACE risk score were used, CRP levels were useless in further risk stratification improvement. In clinical practice, in terms of coinciding infection, problems with CRP levels interpretation can occur as well. Several patients either in cardiogenic shock or after cardiopulmonary resuscitation have signs of systemic inflammatory response, and sometimes it is very difficult to decide whether there is a necessity to iniciate the antibio-tic therapy because of infectious cause. In patients after cardiopulmonary resuscitation, CRP levels > 180 mg/ l indicate highly probable infection, but with the poor sensitivity. For patients in cardiogenic shock, procalcitonin appears to be more useful for the detection of infection; in this group of patients, procalcitonin levels > 2 ng/ ml are common, and levels > 10 ng/ ml indicate infection undoubtedly.

Topics: Acute Coronary Syndrome; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Czech Republic; Humans; Inflammation Mediators; Interleukin-6; Myocardial Infarction; Prognosis; Protein Precursors

Procalcitonin (PCT) levels are below the detection level in healthy subjects, while pre-procalcitonin mRNA is over expressed in human medullar thyroid carcinoma, in small cell lung tumor, and occasionally in other rare neuroendocrine tumors such as phaeochromocytoma. PCT is known as a sensitive and specific biomarker for bacterial sepsis, being produced by extra-thyroidal parenchymal tissues, mainly hepatocytes. The increase in plasma level correlates with the severity of infection and the magnitude and the time course of its increase can be strictly related to the patient's outcome, and to the bacterial load. So far, data on serum PCT levels in patients with cardiogenic shock and in those with acute coronary syndromes (ACS) are scarce and controversial. While some studies report that PCT levels are increased in ACS patients on admission, other investigations document that plasma PCT concentrations are in the normal range. We recently reported that the degree of myocardial ischemia (clinically indicated by the whole spectrum of ACS, from unstable angina to cardiogenic shock following ST-elevation myocardial infarction) and the related inflammatory-induced response are better reflected by C-reactive protein (which was positive in most acute cardiac care patients of all our subgroups) than by PCT, which seems more sensitive to a higher degree of inflammatory activation, being positive only in patients with cardiogenic shock. Few studies investigated the dynamics of PCT in cardiac acute patients, and, despite the paucity of data and differences in patients' selection criteria, an increase in PCT values seems to be associated with the development of complications. In acute cardiac patients, the clinical values of procalcitonin rely not on its absolute value, but only on its kinetics over time.

Topics: Acute Coronary Syndrome; Acute Disease; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Protein Precursors; Sepsis; Shock, Cardiogenic

Contrast-induced acute kidney injury (CI-AKI) is a major issue after percutaneous coronary intervention (PCI), especially in the setting of acute coronary syndrome (ACS). Contrast-induced acute kidney injury is associated with increased mortality and morbidity. Inflammation plays an important role in the pathophysiology of CI-AKI. Procalcitonin (PCT) is introduced as a new marker of inflammation. We sought to examine whether admission PCT levels predict the development of CI-AKI. Patients (n = 814) were divided into 2 groups, namely, CI-AKI (-) and CI-AKI (+). An increase in serum creatinine of ≥0.5 mg/dL from baseline within 48 to 72 hours of contrast exposure was defined as CI-AKI. Contrast-induced acute kidney injury occurred in 96 (11.8%) patients. The PCT levels were significantly higher in patients with CI-AKI than in those without, 0.11 (0.056-0.495) vs 0.04 (0.02-0.078) µg/L; P < .001. After multivariable analysis, PCT remained a significant independent predictor of CI-AKI (odds ratio 2.544; 95% CI [1.207-5.347]; P = .014) as well as age, women, white blood cell, hemoglobin, glomerular filtration rate, creatine kinase myocarial band, and SYNTAX score. In conclusion, serum PCT levels are independently associated with a risk of CI-AKI in patients with ACS who underwent urgent PCI.

Topics: Acute Coronary Syndrome; Acute Kidney Injury; Aged; Aged, 80 and over; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Chi-Square Distribution; Contrast Media; Coronary Angiography; Creatinine; Early Diagnosis; Female; Humans; Inflammation Mediators; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Percutaneous Coronary Intervention; Predictive Value of Tests; Protein Precursors; Risk Factors; Time Factors; Treatment Outcome; Up-Regulation

To evaluate pregnancy-associated plasma protein A (PAPP-A), ischemia-modified albumin (IMA), procalcitonin, and troponin I levels as diagnostic markers of acute coronary syndrome in patients admitted to the emergency department.. The serum PAPP-A, IMA, procalcitonin, and troponin I levels were measured in 100 patients with acute coronary syndrome admitted to the emergency department and 100 healthy control subjects.. Patients with acute coronary syndrome had significantly greater mean serum PAPP-A (patients, 10 ± 10 mIU/L; control subjects, 6 ± 10 mIU/L; P < 0.001), procalcitonin (patients, 2 ± 10 µg/L; control subjects, 0.4 ± 2 µg/L; P < 0.001), and troponin I levels (patients, 6 ± 8 µg/L; control subjects, 0.2 ± 0.3 µg/L; P < 0.001) than control subjects. There was no difference in mean IMA levels between patients and control subjects. There were no significant correlations between PAPP-A levels and IMA, procalcitonin, or troponin I levels in patients with acute coronary syndrome.. The PAPP-A, procalcitonin, and troponin I levels were increased in patients with acute coronary syndrome. Therefore, elevated PAPP-A and procalcitonin levels, in addition to troponin I levels, may be useful markers of myocardial injury on admission to the emergency department.

Topics: Acute Coronary Syndrome; Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Case-Control Studies; Electrocardiography; Emergency Service, Hospital; Female; Humans; Male; Middle Aged; Myocardial Infarction; Pregnancy-Associated Plasma Protein-A; Protein Precursors; Risk Factors; Serum Albumin; Serum Albumin, Human; Troponin I; Young Adult

Available evidence on the prognostic role of procalcitonin levels in acute coronary syndromes (ACS) is so far controversial.. To evaluate the association between procalcitonin, major cardiovascular events (MACE) and total mortality in acute coronary syndromes.. Procalcitonin levels were measured in 247 patients admitted to our Intensive Cardiac Care Unit (ICCU) with ACS. Three subgroups were considered according to procalcitonin levels.. At Cox regression analysis, procalcitonin levels were both an unadjusted and an adjusted predictor (corrected for diagnosis and TnI) of intra-ICCU mortality and of 1-year follow-up MACE and total mortality.. In ACS, admission procalcitonin values identify a "higher risk" group of patients for short and long-term mortality.

Topics: Acute Coronary Syndrome; Aged; Aged, 80 and over; Angina, Unstable; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Diagnostic Tests, Routine; Female; Follow-Up Studies; Humans; Intensive Care Units; Italy; Male; Middle Aged; Patient Admission; Pilot Projects; Prognosis; Protein Precursors; Regression Analysis; Retrospective Studies; Risk Factors; Severity of Illness Index; Shock, Cardiogenic; Troponin I

Procalcitonin is a calcitonin precursor that is used as an inflammatory biomarker in the plasma of patients with sepsis.. The aim of this study was to determine the diagnostic accuracy of emergency department (ED) point-of-care blood procalcitonin testing in identifying myocardial infarction (MI) in patients with chest pain of presumed ischemic origin.. Patients over 18 years of age who presented to the ED with MI-typical chest pain of presumed ischemic origin were included in the study. An initial point-of-care blood sample was drawn from each study patient for testing procalcitonin, troponin T, myoglobin, and creatine kinase-MB levels. A second sample was taken 4h after admission for a procalcitonin test. Finally, a 6-h post-admission blood sample was taken to measure troponin T, myoglobin, and creatine kinase-MB levels in each study patient who had an initial negative cardiac marker test.. A total of 1008 patients with chest pain were admitted to the ED during the study period, and a total of 141 patients met study criteria and were entered into the study. ED point-of-care blood procalcitonin testing to identify myocardial infarction in patients with chest pain of presumed ischemic origin had a sensitivity of 38.3% (95% confidence interval [CI] 28.8-47.3%) and a specificity of 77.8% (95% CI 70.0-84.4%), a positive likelihood ratio (LR+) of 1.725 and a negative likelihood ratio (LR-) of 0.792. The 4th hour diagnostic values (sensitivity, specificity, LR+ and LR-) of procalcitonin semi-quantitative (PCT-Q) testing were 90% (95% CI 80.9-95.7%), 59.3% (95% CI 52.5-63.5%), 2.2, and 0.16, respectively.. ED point-of-care testing for procalcitonin had poor diagnostic accuracy for predicting myocardial infarction.

Topics: Acute Coronary Syndrome; Adult; Aged; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Chest Pain; Emergency Service, Hospital; Female; Humans; Inflammation; Male; Middle Aged; Myocardial Infarction; Point-of-Care Systems; Prospective Studies; Protein Precursors; Sensitivity and Specificity

Topics: Acute Coronary Syndrome; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Prognosis; Protein Precursors

To examined whether serum paraoxonase (PON1) and arylesterase (ARE) activities are correlated with inflammatory biomarkers (procalcitonin and high sensitivity C-reactive protein (hs-CRP) in patients with acute coronary syndrome (ACS).. This cross-sectional study was conducted at the Departments of Cardiology and Biochemistry, Uludag University School of Medicine, Bursa, Turkey, from April 2007 to December 2007. Seventy-eight consecutive patients with ACS and 39 healthy controls were investigated. Acute coronary syndrome patients were divided into 3 groups according to their clinical presentation: unstable angina pectoris (UAP) (Braunwald III-B, n=25), non-ST elevation myocardial infarction (NSTEMI) (n=18), and ST-elevation myocardial infarction (STEMI) (n=35). Serum PON1/ARE activities were measured spectrophotometrically. Levels of procalcitonin and hs-CRP were measured by immunoassay.. Paraoxonase/ARE activities were significantly lower in all patient groups compared to controls. No correlation between PON1/ARE activities and high-density-cholesterol levels was seen. Among ACS patients, serum ARE activity correlated inversely with baseline and 48-hour procalcitonin (r=-0.577, p=0.009, and r=-0.642, p=0.019) and hs-CRP levels (r=-0.614, p=0.03, and r=-0.719, p=0.044).. Serum ARE activity is reduced in ACS patients and inversely correlated with inflammatory markers.

Topics: Acute Coronary Syndrome; Aryldialkylphosphatase; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Carboxylic Ester Hydrolases; Case-Control Studies; Chi-Square Distribution; Cross-Sectional Studies; Female; Humans; Inflammation; Male; Middle Aged; Protein Precursors; Statistics, Nonparametric

Procalcitonin (PCT) is known to be a biological diagnostic marker for severe sepsis, or septic shock in critically ill patients. There are still contrasting data about a role of procalcitonin in patients with acute myocardial infarction or cardiogenic shock, and in those with acute coronary syndromes, that is, non-ST-elevation myocardial infarction or unstable angina. We evaluated plasma levels of procalcitonin and C-reactive protein (CRP) in 52 patients admitted to our intensive cardiac care unit (ICCU): 14 patients with cardiogenic shock (CS) following ST-elevation myocardial infarction (STEMI), 15 patients with uncomplicated ST-elevation myocardial infarction (STEMI), and 24 with non-ST-elevation myocardial infarction or unstable angina (NSTEMI/UA). In all patients, infective processes were excluded. Procalcitonin values were significantly higher in CS patients with respect to the other two subgroups (P < 0.001, P < 0.001) while CRP levels were higher than NSTEMI/UA patients (P < 0.001) but not with respect to STEMI patients (P = 0.063). No correlations were found in cardiogenic shock patients between CRP and PCT values (R = 0.02; P = 0.762, ns). Procalcitonin levels measured on ICCU admission are significantly higher in patients with cardiogenic shock following the acute myocardial infarction, and they are not correlated with those of CRP. The degree of myocardial ischemia (clinically indicated by the whole spectrum of ACS, from unstable angina to cardiogenic shock ST-elevation following myocardial infarction) and the related inflammatory-induced response are better reflected by CRP (which was positive in most acute cardiac care patients of all our subgroups), than by PCT which seems more reflective of a higher degree of inflammatory activation, being positive only in all CS patients.

Topics: Acute Coronary Syndrome; Aged; Aged, 80 and over; Angina, Unstable; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Inflammation; Intensive Care Units; Italy; Male; Middle Aged; Myocardial Infarction; Protein Precursors; Shock, Cardiogenic

Topics: Acute Coronary Syndrome; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Protein Precursors