Incresed inflammatory response in patients with the first myocardial infarction and nonsignificant stenosis of infarct-related artery

Nenad Ratkovic, Dragan Dincic, Branko Gligic, Snjezana Vukotic, Aleksandra Jovelic, Slobodan Obradovic
2012 Vojnosanitetski Pregled  
Introduction/Aim. Atherosclerosis presents a serial of highly specific cellular and molecular responses, and could be described as inflammatory diseases. Accordingly, for development of acute myocardial infarction (AMI), structure and vulnerability of atherosclerotic plaque are more important than the extent of stenosis of infarct-related artery. Consequently, inflammation and atherosclerosis and its complications are in good correlation. C-reactive protein (CRP) as nonspecific inflammatory
more » ... ic inflammatory marker, has prognostic significance in coronary artery diseases. The aim of this study was to establish the correlation between inflammatory response expressed as levels of CRP and fibrinogen in serum and extent of coronary artery stenosis. Methods. Study included 35 patients with acute myocardial infarction, as the first manifestation of coronary artery disease, which were treated with thrombolytic therapy according to the guidelines. All the patient had a reperfusion. The patients with acute or chronic inflammatory diseases, an increased value of sedimentation, fibrinogen, CK 190 U/L, early and late complications of AMI were excluded. CRP was measured on admission, after 24, 48 and 72 hrs, and 21 days latter, while fibriogen only on admission. Results. All the patients underwent coronary angiography, and were divided into two groups: the group 1 (23 patients), with significant stenosis of infarct-related artery (stenosis 75%), and the group 2 (13 patients) without significant stenosis (< 75%). Mean value of CRP serum level on admission in the group 1 was 4.4 mg/L, and in the group 2 7.2 mg/L (p < 0.001). The mean value of fibrinogen on admission in the group 1 was 2.7 g/L, and in the group 2 3.0 g/L (p < 0.001). The mean CRP value after 48 hrs in the group 1 was 21.7 mg/L, and in the group 2 42.4 mg/L. (p < 0.001). After three weeks, the mean CRP value was 4 mg/L in the group 1 and 5.5 mg/L in the group 2 (p < 0.001). There was no significant difference between the groups 1 and 2 related to gender, age, localization of AMI, CK, EF value, and risk factors for coronary artery disease. Conclusion. The patients with nonsignificant stenosis of infarct-related artery had increased inflammtory responses according to the CRP value, as a result of inflammatory process in atherosclerotic plaque and/or enhanced individual reactivity. Apstrakt Uvod/Cilj. Ateroskleroza predstavlja seriju visokospecifi nih celularnih i molekularnih odgovora, koji se najbolje mogu opisati kao inflamatorno oboljenje. U tom kontekstu, za nastanak akutnog infarkta miokarda (AIM) sastav i vulnerabilnost ateroskelrotske plo e mogu biti zna ajniji od stepena stenoze infarktne arterije (IA), odnosno biološko, inflamatorno stanje, može biti pokazatelj kojom e se brzinom i smerom razvijati ateroskleroza i njene komplikacije. Cilj rada bio je da se ustanovi da li postoji korelacija izme u inflamatornog odgovora, prikazanog c-reaktivnim proteinom (CRP) i fibri-nogenom i stepena stenoze infarktne arterije (IA) kod bolesnika sa AIM, kao prvom manifestacijom koronarne bolesti. Metode. Istraživanjem je bilo obuhva eno 35 bolesnika sa AIM, kao prvom manifestacijom koronarne bolesti, koji su le eni tromboliti kom terapijom po važe im preporukama. Bili su uklju eni samo bolesnici sa koronarogafki dokazanom reperfuzijom koronorne arterije. Istraživanjem nisu bili obuhva eni bolesnici sa akutnim i hroni nim inflamatornim oboljenima, zatim bolesnici koji su na prijemu imali povišenu sedimentaciju (SE), fibrinogen, kreatinin-kinazu (CK) 190 U/L, kao ni oni sa ranim i kasnim komplikacijama AIM. Creaktivni protein odre ivan je odmah po prijemu, potom 24, Strana 788 VOJNOSANITETSKI PREGLED Volumen 69, Broj 9 Ratkovi N, et al. Vojnosanit Pregl 2012; 69(9): 787-793. 48, 72 sata nakon prijema, te 21. dana od hospitalizacije. Fibrinogen je odre ivan samo na prijemu. Rezultati. Na osnovu koronarografskog nalaza bolesnici su bili podeljeni u dve grupe: grupa 1 (23 bolesnika) bez zna ajne stenoze IA (stenoza 75%), i grupa 2 (13 bolesnika) sa zna ajnom stenozom IA (stenoza < 75% ). Srednja vrednost CRP na prijemu u grupi 1 iznosila je 4,4 mg/L, a u grupi 2 7,2 mg/L (p < 0,001). Srednja vrednost CRP nakon 48 sati u grupi 1 bila je 21,7 mg/L, a u grupi 2 42,4 mg/L (p < 0,001). Srednja vrednost fibrinogena na prijemu u grupi 1 bila je 2,7 g/L, a u grupi 2 3,0 g/L, (p < 0,001). Nakon tri nedelje vrednost CRP u grupi 1 bila je 4 mg/L, a u grupi 2 je 5,5 mg/L ( p < 0,001 ). Grupe se statisti-ki nisu razlikovale po polu, godinama, lokaciji AIM, vrednostima CK, EF i faktorima rizika od koronarne bolesti. Zaklju ak. Kod bolesnika sa nesignifikantnom stenozom infarktne arterije postoji poja an inflamatorni odgovor akutne faze. Ovo pokazuje da postoje razli iti patogenetski mehanizami u nastanku iste klini ke slike i/ili razli ite individualne reaktivnosti na inflamatorni stimulus. Klju ne re i: ateroskleroza; infarkt miokarda; inflamacija; koronarna arterija, stenoza; akutna bolest; c-reaktivni protein; fibrinogen.
doi:10.2298/vsp110302010r pmid:23050404 fatcat:yvpuesxps5b6xonjisj3fjz3vu