transforming-growth-factor-beta and ST-Elevation-Myocardial-Infarction

BACKGROUND The aim of the present study was to develop a risk prediction model in patients with acute anterior ST-segment elevation myocardial infarction (STEMI). MATERIAL AND METHODS Clinical data from 333 patients with acute anterior STEMI were retrospectively analyzed. Clinical echocardiographic and angiographic data from patients with left ventricular remodeling (LVR) and those without LVR were compared. Factors that influenced risk were identified using multivariate logistic regression analysis. The area under the curve (AUC) of the receiver operating characteristic curve was used to assess the diagnostic performance of the model. RESULTS After 6-month follow-up, 135 of the patients experienced LVR (LVR group), whereas 198 did not (non-LVR group). Results of multivariate analysis showed that the number of stenosed coronary vessels, left ventricular end-diastolic volume (LVEDV), left ventricular ejection fraction (LVEF), transforming growth factor-beta (TGF-ß) at admission, and cardiac troponin I 3 days after admission (3-d cTnI) were all factors predictive of LVR in patients with acute anterior STEMI (all P<0.05). The established prediction model was Y=-20.639+0.711×number of stenosed coronary vessels + 0.137×LVEDV-0.129×LVEF+0.026×TGF-ß at admission + 0.162×3-d cTnI. The estimated AUC of this model was 0.978 (95% confidence interval [CI] 0.955-0.991), significantly superior to the single-factor numbers for stenosed coronary vessel of 0.650 (95% CI 0.597-0.702), LVEDV of 0.876 (95% CI 0.836-0.910), LVEF of 0.684 (95% CI 0.631-0.734), TGF-ß at admission of 0.696 (95% CI 0.644-0.745), cTnI at admission of 0.913 (95% CI 0.877-0.941), and 3-d cTnI of 0.945 (95% CI 0.914-0.967). CONCLUSIONS The established model had excellent diagnostic accuracy for predicting LVR in patients with acute anterior STEMI.

Topics: Acute Disease; Biomarkers; Echocardiography; Female; Follow-Up Studies; Humans; Male; Middle Aged; Predictive Value of Tests; Reproducibility of Results; Retrospective Studies; Risk Assessment; ST Elevation Myocardial Infarction; Transforming Growth Factor beta; Troponin I; Ventricular Remodeling

Patients with acute coronary syndrome show an inflammatory response that is known to affect platelet aggregation. We aimed to clarify the relationship between the inflammation severity and the effect of antiplatelet therapy after percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).. This retrospective, single-center study included 203 patients with STEMI who underwent primary PCI and were stratified on the basis of the antiplatelet therapy on admission (clopidogrel vs ticagrelor). Inflammation levels were defined as low, intermediate, and high, based on the tertiles of the distribution of high-specificity C-reactive protein levels pre-PCI. Platelet aggregation function during hospitalization and follow-up was quantified as residual adenosine diphosphate-induced platelet reactivity on light transmittance aggregometry. Inflammation markers were measured on admission and at 1 year post-PCI.. At intermediate and high levels of inflammation, residual adenosine diphosphate-induced platelet aggregation was significantly higher among clopidogrel users than among ticagrelor users. In the clopidogrel group, statistically significant differences in platelet aggregation function were observed among the 3 levels of inflammation. At 1 year post-PCI, ticagrelor users had significantly lower levels of interleukin-1β and higher levels of interleukin-35 and transforming growth factor-β.. At different inflammation levels, ticagrelor provides more potent platelet inhibition than clopidogrel, suggesting that ticagrelor might exert a more stable antiplatelet effect at higher levels of systemic inflammation. Furthermore, ticagrelor is associated with reduced indices of inflammation on follow-up after PCI, suggesting that anti-inflammatory effects might play a role in the clinical benefit observed with antiplatelet therapy, which would provide an additional rationale for using ticagrelor in patients with STEMI undergoing primary PCI.

Topics: Biomarkers; C-Reactive Protein; Clopidogrel; Female; Humans; Interleukin-1beta; Interleukins; Male; Middle Aged; Percutaneous Coronary Intervention; Platelet Aggregation; Platelet Aggregation Inhibitors; Retrospective Studies; ST Elevation Myocardial Infarction; Ticagrelor; Transforming Growth Factor beta; Tumor Necrosis Factor-alpha