Early cardiopulmonary resuscitation on serum levels of myeloperoxidase,soluble ST2,and hypersensitive C-reactive protein in acute myocardial infarction patients

BACKGROUND Prompt and effective cardiopulmonary resuscitation(CPR)can promote the recovery of spontaneous circulation to some extent and can save patients’lives.The minimum target of cardiac resuscitation is the restoration of spontaneous circulation(ROSC).However,owing to prolonged sudden cardiac arrest,there is relatively high mortality within 24 h after cardiac resuscitation.Moreover,severe cerebral anoxia can deteriorate the prognosis of patients.Therefore,it is important to adopt an effective clinical evaluation of acute myocardial infarct(AMI)patients’prognosis after cardiac resuscitation for the purpose of prevention and management.AIM To investigate early CPR effects on human myeloperoxidase(MPO),soluble ST2(sST2),and hypersensitive C-reactive protein(hs-CRP)levels in AMI patients.METHODS In total,54 patients with cardiac arrest caused by AMI in our hospital were selected as the observation group,and 50 other patients with AMI were selected as the control group.The differences in serum levels of MPO,sST2,and hs-CRP between the observation group and the control group were tested,and the differences in the serum levels of MPO,sST2,and hs-CRP in ROSC and non-ROSC patients,and in patients who died and in those who survived,were analyzed.RESULTS Serum levels of MPO,sST2,hs-CRP,lactic acid,creatine kinase isoenzyme(CKMB),and cardiac troponin I(cTnI)were significantly higher in the observation group than in the control group(P<0.05).Serum levels of MPO,sST2,hs-CRP,lactic acid,CK-MB,and cTnI in the observation group were lower after CPR than before CPR(P<0.05).In the observation group,MPO,sST2,hs-CRP,lactic acid,CK-MB,and cTnI serum levels were lower in ROSC patients than in non-ROSC patients(P<0.05).MPO,sST2,hs-CRP,and lactic acid serum levels of patients who died in the observation group were higher than those of patients who survived(P<0.05).The areas under receiver operating characteristic curve predicted by MPO,sST2,hs-CRP,lactic acid,CK-MB,and cTnI were 0.616,0.681,0.705,0.704,0.702,and 0.656,respectively(P<0.05).The areas under receiver operating characteristic curve for MPO,SST2,hs-CRP,and lactic acid to predict death were 0.724,0.800,0.689,and 0.691,respectively(P<0.05).Logistic regression analysis showed that MPO,sST2,and hs-CRP were the influencing factors of ROSC[odds ratios=1.667,1.589,and 1.409,P<0.05],while MPO,sST2,hs-CRP,and lactic acid were the influencing factors of death(odds ratios=1.624,1.525,1.451,and 1.365,P<0.05).CONCLUSION Serum levels of MPO,sST2,hs-CRP,and lactic acid have a certain value in predicting recovery and prognosis of patients with ROSC.

Relationship among soluble CD105, hypersensitive C-reactive protein and coronary plaque morphology： an intravascular ultrasound study

Background Rupture of unstable plaque with subsequent thrombus formation is the common pathophysiological substrate of acute coronary syndrome （ACS）. It is of potential significance to explore the blood indexes predicting plaque characteristics. We investigated the relationship among soluble CD105, hypersensitive C-reactive protein （hs-CRP）, and coronary plaque morphology.Methods A clinical study from April 2004 to December 2006 was conducted in 130 patients who were divided into 3 groups： 56 patients （43.1%） in stable angina （SA） group, 52 patients （40.0%） in unstable angina （UA） group and 22 patients （16.9%） in acute myocardial infarction group. The concentrations of soluble CD105 and hs-CRP were measured in all of the patients by cardioangiography （CAG）. Plasma samples of arterial blood were collected prior to the procedure. The levels of soluble CD105 and hs-CRP were measured by enzyme-linked immunosorbent assay （ELISA）.Results Unstable and ruptured plaque was found more frequently in patients with acute myocardial infarction and UA. External elastic membrane cross-sectional area （EEM CSA）, plaque area, lipid pool area and plaque burden were significantly larger in the ruptured and unstable plaque group. Positive remodeling, thinner fabric-cap, smaller minimal lumen cross-sectional area （MLA）, dissection and thrombus were significantly more frequent in the ruptured and unstable plaque group. Remodeling index （RI） was positively correlated with the levels of soluble CD105 in the UA group （r=0.628, P〈0.01） and the acute myocardial infarction group （r=0.639, P〈0.01）. The levels of soluble CD105 and hs-CRP were higher in the ruptured plaque group. Soluble CD105 〉4.3 ng/ml was used to predict ruptured plaque with a receiver operating characteristic （ROC） curve area of 0.77 （95% confidence interval （CI）, 66.8%-87.2%）, a sensitivity of 72.8%, a specificity of 78.0% and an accuracy of 70.2% （P〈0.01）, similarly for hs-CRP 〉 5.0 mg/ml with a ROC curve area of 0.70 （95% CI, 59.2%-80.2%）, a sensitivity of 70.2%, a specificity of 76.2% and an accuracy of 67.2% （P〈0.01）.Conclusions The plaque characteristics correlate with the clinical presentation. The elevation of soluble CD105 and hs-CRP is related to the plaque instability and rupture.

Analysis of correlation between carotid atherosclerotic plaques and serum hs-CRP, Apo-B, ox-LDL and MMP-9 levels in patients with atherosclerotic cerebral infarction

ObjectiveTo analyze the correlation between the levels of serum hypersensitive c-reactive protein(hs-CRP),apolipoprotein-B(Apo-B),oxidized low-density lipoprotein(ox-LDL)and matrix metalloproteinase-9(MMP-9)and carotid arteryplaque(CAP)in patients with atherosclerotic cerebral infarction(ASCI).Methods 125 patients with ASCI diagnosed in the Department of Neurology of Panzhihua Central Hospital from January 2018 to December 2018 were selected as the case group,and 125 healthy volunteers in the same period were selected as the control group.Serum levels of hs-CRP,Apo-B,ox-LDL and MMP-9 were compared between the two groups.Carotid ultrasound was performed in patients with ASCI.The correlation between serum levels of hs-CRP,Apo-B,ox-LDL and MMP-9 and the formation of CAP in patients with ASCI was analyzed by SPSS 23.0 statistics.Results Compared with the control group,the levels of serum hs-CRP,Apo-B,ox-LDL and MMP-9 increased significantly in the case group(P<0.01).The serum levels of hs-CRP,Apo-B,ox-LDL and MMP-9 in patients with CAP were significantly higher than those without CAP in the case group(P<0.01).Multivariate logistic regression analysis showed that serum levels of hs-CRP(OR=4.76,95%CI:2.35-9.18),Apo-B(OR=3.16,95%CI:1.59-7.32),ox-LDL(OR=1.48,95%CI:1.15-2.01)and MMP-9(OR=3.86,95%CI:1.63-9.14)were independent risk factors for CAP formation in patients with ASCI(P<0.05).ConclusionsThe contents of serumhs-CRP,Apo-B,ox-LDL and MMP-9 may reflect the serverity of inflammation and instability of carotid atherosclerotic plaque in ASCI patient.The levels of serum hs-CRP,Apo-B,ox-LDL and MMP-9 in patients with ASCI are significantly increased,which are closely related to the formation of CAP in patients with ASCI,so it can be used as important serum biomarkers for clinical diagnosis of ASCI and CAP formation.

Biomarkers enhance the long-term predictive ability of the KAMIR risk score in Chinese patients with ST-elevation myocardial infarction

Background:The Global Registry of Acute Coronary Events (GRACE) score is recommended by current ST-elevation myocardial infarction (STEMI) guidelines.But it has inherent defects.The present study aimed to investigate the more compatible risk stratification for Chinese patients with STEMI and to determine whether the addition of biomarkers to the Korea Acute Myocardial Infarction Registry (KAMIR) score could enhance its predictive value for long-term outcomes.Methods:A total of 1093 consecutive STEMI patients were included and followed up 48.2 months.Homocysteine,hypersensitive C-reactive protein (hs-CRP),and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were detected.The KAMIR score and the GRACE score were calculated.The performance between the KAMIR and the GRACE was compared.The predictive power of the KAMIR alone and combined with biomarkers were assessed by the receiver-operating characteristic (ROC) curve.Results:The KAMIR demonstrated a better risk stratification and predictive ability than the GRACE (death:AUC = 0.802 vs.0.721,P<0.001;major adverse cardiovascular events (MACE):AUC = 0.683 vs.0.656,P<0.001).It showed that the biomarkers could independently predict death [homocysteine:HR= 1.019 (1.015–1.024),P<0.001;hs-CRP:HR= 1.052 (1.000–1.104),P= 0.018;NT-pro BNP:HR= 1.142 (1.004–1.280),P= 0.021] and MACE [homocysteine:HR= 1.019 (1.015–1.024),P<0.001;hs-CRP:HR= 1.012 (1.003–1.021),P= 0.020;NT-pro BNP:HR= 1.136 (1.104–1.168),P= 0.006].When they were used in combination with the KAMIR,the area under the ROC curve (AUC) significantly increased for death [homocysteine:AUC = 0.802 vs.0.890,Z = 5.982,P<0.001;hs-CRP:AUC = 0.802 vs.0.873,Z= 3.721,P<0.001;NT-pro BNP:AUC= 0.802 vs.0.871,Z = 2.187,P= 0.047;homocysteine,hs-CRP and NT-pro BNP:AUC = 0.802 vs.0.940,Z = 6.177,P<0.001] and MACE [homocysteine:AUC = 0.683 vs.0.771,Z= 6.818,P<0.001;hs-CRP:AUC= 0.683 vs.0.712,Z= 2.022,P= 0.031;NT-pro BNP:AUC= 0.683 vs.0.720,Z= 2.974,P= 0.003;homocysteine,hs-CRP and NT-pro BNP:AUC= 0.683 vs.0.789,Z= 6.900,P<0.001].Conclusion:The KAMIR is better than the GRACE in risk stratification and prognosis prediction in Chinese STEMI patients.A combination of above-mentioned biomarkers can develop a more predominant prediction for long-term outcomes.