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Wang L, Huang S, Zhou Q, Dou L, Lin D. The predictive value of laboratory parameters for no-reflow phenomenon in patients with ST-elevation myocardial infarction following primary percutaneous coronary intervention: A meta-analysis. Clin Cardiol 2024; 47:e24238. [PMID: 38400562 PMCID: PMC10891415 DOI: 10.1002/clc.24238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
To date, the predictive role of laboratory indicators for the phenomenon of no flow is unclear. Hence, our objective was to conduct a meta-analysis to investigate the association between laboratory parameters and the risk of the no-reflow phenomenon in patients with ST-elevation myocardial infarction (STEMI) following primary percutaneous coronary intervention (PCI). This, in turn, aims to offer valuable insights for early clinical prediction of no-reflow. We searched Pubmed, Embase, and Cochrane Library from the establishment of the database to October 2023. We included case-control or cohort study that patients with STEMI following primary PCI. We excluded repeated publication, research without full text, incomplete information or inability to conduct data extraction and animal experiments, reviews, and systematic reviews. STATA 15.1 was used to analyze the data. The pooled results indicated that elevated white blood cell (WBC) count (odds ratio [OR] = 1.061, 95% confidence interval [CI]: 1.013-1.112), neutrophil count (OR = 1.324, 95% CI: 1.128-1.553), platelet (PLT) (OR = 1.002, 95% CI: 1.000-1.005), blood glucose (OR = 1.005, 95% CI: 1.002-1.009), creatinine (OR = 1.290, 95% CI: 1.070-1.555), total cholesterol (TC) (OR = 1.022, 95% CI: 1.012-1.032), d-dimer (OR = 1.002, 95% CI: 1.001-1.004), and fibrinogen (OR = 1.010, 95% CI: 1.005-1.015) were significantly associated with increased risk of no-reflow. However, elevated hemoglobin was significantly associated with decreased risk of no-reflow. In conclusion, our comprehensive analysis highlights the predictive potential of various parameters in assessing the risk of no-reflow among STEMI patients undergoing PCI. Specifically, WBC count, neutrophil count, PLT, blood glucose, hemoglobin, creatinine, TC, d-dimer, and fibrinogen emerged as significant predictors. This refined risk prediction may guide clinical decision-making, allowing for more targeted and effective preventive measures to mitigate the occurrence of no-reflow in this patient population.
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Affiliation(s)
- LinLi Wang
- Department of Preventive Medicine, Children's HospitalZhejiang University School of Medicine, National Clinical Research Center for Child HealthHangzhouChina
| | - ShuWei Huang
- Department of CardiologyThe First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)HangzhouChina
| | - Qiujun Zhou
- Department of First Clinical Medical CollegeZhejiang Chinese Medical UniversityHangzhouChina
| | - LiPing Dou
- Department of CardiologyThe Second Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
| | - Dongming Lin
- Department of CardiologyThe First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)HangzhouChina
- Department of First Clinical Medical CollegeZhejiang Chinese Medical UniversityHangzhouChina
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Reindl M, Tiller C, Holzknecht M, Lechner I, Henninger B, Mayr A, Brenner C, Klug G, Bauer A, Metzler B, Reinstadler SJ. Association of Myocardial Injury With Serum Procalcitonin Levels in Patients With ST-Elevation Myocardial Infarction. JAMA Netw Open 2020; 3:e207030. [PMID: 32539151 PMCID: PMC7296390 DOI: 10.1001/jamanetworkopen.2020.7030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
IMPORTANCE Myocardial tissue injury due to acute ST-elevation myocardial infarction (STEMI) initiates an inflammatory response that leads to a release of systemic inflammatory biomarkers, including C-reactive protein (CRP) and white blood cells, consequently reducing the usefulness of these routine biomarkers for identifying concomitant infections. The clinical role of procalcitonin (PCT), a promising marker of bacterial infection, to detect concomitant infection in acute STEMI is unknown, mainly because it is unclear whether myocardial injury per se induces systemic PCT release. OBJECTIVE To investigate the release of serum PCT in the acute setting of STEMI (24 and 48 hours after primary percutaneous coronary intervention) and to elucidate any associations with myocardial injury markers through a comprehensive assessment by cardiac magnetic resonance (CMR) imaging. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study conducted between 2016 and 2018 included 141 consecutive patients with STEMI treated with primary percutaneous coronary intervention. Concentrations of PCT, high-sensitivity CRP (hs-CRP), and high-sensitivity cardiac troponin T (hs-cTnT) and white blood cell counts were measured serially 24 and 48 hours after infarct. EXPOSURES Acute STEMI and primary percutaneous coronary intervention. MAIN OUTCOMES AND MEASURES The association of PCT and typical inflammatory marker levels with CMR-determined myocardial damage was assessed. Infarct size, extent of microvascular obstruction, and occurrence of intramyocardial hemorrhage as determined by CMR within the first week following STEMI were also evaluated. RESULTS In total, 141 patients with STEMI (117 men [83%]) having a median age of 56 years (interquartile range, 50-66 years) were included. The median PCT concentration was 0.07 μg/L (interquartile range, <0.06-0.11 μg/L) 24 hours after intervention and 0.07 μg/L (interquartile range, <0.06-0.09 μg/L) 48 hours after intervention. Whereas hs-CRP and hs-cTnT levels and white blood cell counts were significantly correlated with CMR markers of myocardial damage at both 24 and 48 hours after intervention, the PCT level showed no significant correlation with infarct size (at 24 hours: r = 0.07; P = .40; at 48 hours: r = 0.13; P = .12) or with microvascular obstruction (at 24 hours: r = -0.03; P = .75; at 48 hours: r = 0.09; P = .30). Furthermore, PCT levels at 24 hours (odds ratio, 1.25; 95% CI, 0.63-2.48; P = .52) and 48 hours (odds ratio, 1.56; 95% CI, 0.72-3.41; P = .26) were not significantly associated with the presence of intramyocardial hemorrhage. CONCLUSIONS AND RELEVANCE In the acute phase after percutaneous coronary intervention for STEMI, circulating PCT levels remained unassociated with the extent of myocardial and microvascular tissue damage as visualized by CMR imaging.
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Affiliation(s)
- Martin Reindl
- Cardiology and Angiology, University Clinic of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
| | - Christina Tiller
- Cardiology and Angiology, University Clinic of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
| | - Magdalena Holzknecht
- Cardiology and Angiology, University Clinic of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
| | - Ivan Lechner
- Cardiology and Angiology, University Clinic of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
| | - Benjamin Henninger
- University Clinic of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Agnes Mayr
- University Clinic of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Brenner
- Cardiology and Angiology, University Clinic of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
| | - Gert Klug
- Cardiology and Angiology, University Clinic of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
| | - Axel Bauer
- Cardiology and Angiology, University Clinic of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
| | - Bernhard Metzler
- Cardiology and Angiology, University Clinic of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
| | - Sebastian J. Reinstadler
- Cardiology and Angiology, University Clinic of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
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Ornek E, Cetin M, Kiziltunc E, Kurtul A, Gok M, Kundi H. Association of serum procalcitonin level with in-stent restenosis in patients undergoing bare-metal stent implantation. Biomark Med 2018. [PMID: 29517279 DOI: 10.2217/bmm-2017-0242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Procalcitonin (PCT) is an inflammatory marker and elevated PCT levels are associated with cardiovascular events. We assessed whether PCT level is an independent predictor of bare-metal stent (BMS) in-stent restenosis (ISR). PATIENTS & METHODS We evaluated 240 patients undergoing BMS implantation. Serum PCT levels were measured before procedure. Patients were classified as ISR(-) group (n = 120) and ISR(+) group (n = 120). RESULTS Serum PCT levels were higher in the ISR (+) group (p < 0.001). At multivariate analysis, PCT (odds ratio [OR] 1.561; p = 0.012), stent length (OR: 1.089), stent diameter (OR: 0.141) and uric acid (OR: 1.465) were independent predictors of ISR. CONCLUSION Serum PCT is independently associated with ISR and increased PCT levels may provide useful information for the risk of BMS-ISR.
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Affiliation(s)
- Ender Ornek
- Department of Cardiology, Ankara Numune Education & Research Hospital, Ankara, Turkey
| | - Mustafa Cetin
- Department of Cardiology, Ankara Numune Education & Research Hospital, Ankara, Turkey
| | - Emrullah Kiziltunc
- Department of Cardiology, Ankara Numune Education & Research Hospital, Ankara, Turkey
| | - Alparslan Kurtul
- Department of Cardiology, Ankara Education & Research Hospital, Ankara, Turkey
| | - Murat Gok
- Department of Cardiology, Ankara Numune Education & Research Hospital, Ankara, Turkey
| | - Harun Kundi
- Department of Cardiology, Ankara Numune Education & Research Hospital, Ankara, Turkey
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Cvetinovic N, Isakovic AM, Lainscak M, Dungen HD, Nikolic NM, Loncar G. Procalcitonin in heart failure: hic et nunc. Biomark Med 2017; 11:893-903. [PMID: 28976777 DOI: 10.2217/bmm-2017-0160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Although procalcitonin (PCT) was evaluated for the first time in the setting of heart failure (HF) in 1999, its utility in HF patients is still under examination. Patients with HF have significantly higher plasma PCT concentrations than healthy subjects and PCT levels are associated with severity of HF. It has been confirmed that higher levels of PCT are associated with worse outcomes, such as increased mortality and higher rate of rehospitalization, in HF patients with no evidence of infection. Furthermore, it has been approved that PCT-guided antibiotic treatment in HF patients reduces duration of antibiotic therapy and improves outcomes. This review summarizes current evidence from the published literature of the usefulness and limitations of PCT as a biomarker in HF.
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Affiliation(s)
- Natasa Cvetinovic
- Department of Cardiology, Zvezdara University Medical Center, Belgrade, Serbia
| | | | - Mitja Lainscak
- Department of Internal Medicine, General Hospital Murska Sobota, Slovenia.,Faculty of Medicine, University of Ljubljana, Slovenia
| | - Hans-Durk Dungen
- Department of Cardiology, Campus Virchow, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Natasa Markovic Nikolic
- Department of Cardiology, Zvezdara University Medical Center, Belgrade, Serbia.,School of Medicine, University of Belgrade, Serbia
| | - Goran Loncar
- Department of Cardiology, Zvezdara University Medical Center, Belgrade, Serbia.,School of Medicine, University of Belgrade, Serbia
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Kurtul A, Elcik D. Procalcitonin is an independent predictor for coronary atherosclerotic burden in patients with stable coronary artery disease. Int J Cardiol 2017; 236:61-64. [DOI: 10.1016/j.ijcard.2017.02.061] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/11/2017] [Accepted: 02/19/2017] [Indexed: 12/18/2022]
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Kim SK, Chung JH, Kwon OY. Promoter Polymorphism (-174, G/C) of Interleukin-6 and Arterial Thromboembolic Events: A Meta-Analysis. Med Sci Monit 2016; 22:4345-4353. [PMID: 27840402 PMCID: PMC5120647 DOI: 10.12659/msm.901467] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Ischemic stroke and myocardial infarction are fatal diseases and are among the top 10 causes of death in Korea, including arterial thromboembolic events. Many previous studies have described the function of interleukin-6 (IL-6) in arterial thromboembolic events and the association between promoter single-nucleotide polymorphism (SNP) (rs1800795; −174, G/C) of the IL-6 gene. However, these results were controversial. Therefore, we performed a meta-analysis to more precisely assess the association between the SNP of the IL-6 gene and susceptibility to arterial thromboembolic events. Material/Methods We used PubMed, Embase, Google Scholar, and Korean Studies Information Service System (KISS) electronic databases. Comprehensive Meta-analysis software (Corporation, NJ) was used to evaluate the relationship between rs1800795 SNP of IL-6 gene and risk of arterial thromboembolic events. Odds ratio (OR), 95% confidence interval (CI), and P value were also calculated. The 13 eligible studies were analyzed in the meta-analysis. Results The present meta-analysis found that rs1800795 SNP of IL-6 gene is not significantly associated with susceptibility to arterial thromboembolic events (C allele vs. G allele, OR=1.04, 95% CI=0.91–1.19, P=0.619; CC vs. CG+GG, OR=1.09, 95% CI=0.91–1.31, P=0.364; CC+CG vs. GG, OR=0.97, 95% CI=0.78–1.21, P=0.763, respectively), and the SNP of IL-6 gene also did not show any significant association with ischemic stroke or myocardial infarction (P>0.05 in each model). Conclusions We found that rs1800795 SNP of IL-6 gene was not related to arterial thromboembolic events. However, further study will be needed to confirm these results.
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Affiliation(s)
- Su Kang Kim
- Kohwang Medical Research Institute, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Joo-Ho Chung
- Kohwang Medical Research Institute, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Oh Young Kwon
- Department of Medical Education and Medical Humanities, School of Medicine, Kyung Hee University, Seoul, South Korea
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Pomara C, Riezzo I, Bello S, De Carlo D, Neri M, Turillazzi E. A Pathophysiological Insight into Sepsis and Its Correlation with Postmortem Diagnosis. Mediators Inflamm 2016; 2016:4062829. [PMID: 27239102 PMCID: PMC4863102 DOI: 10.1155/2016/4062829] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/21/2016] [Accepted: 04/10/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Sepsis is among the leading causes of death worldwide and is the focus of a great deal of attention from policymakers and caregivers. However, sepsis poses significant challenges from a clinical point of view regarding its early detection and the best organization of sepsis care. Furthermore, we do not yet have reliable tools for measuring the incidence of sepsis. Methods based on analyses of insurance claims are unreliable, and postmortem diagnosis is still challenging since autopsy findings are often nonspecific. AIM The objective of this review is to assess the state of our knowledge of the molecular and biohumoral mechanisms of sepsis and to correlate them with our postmortem diagnosis ability. CONCLUSION The diagnosis of sepsis-related deaths is an illustrative example of the reciprocal value of autopsy both for clinicians and for pathologists. A complete methodological approach, integrating clinical data by means of autopsy and histological and laboratory findings aiming to identify and demonstrate the host response to infectious insults, is mandatory to illuminate the exact cause of death. This would help clinicians to compare pre- and postmortem findings and to reliably measure the incidence of sepsis.
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Affiliation(s)
- C. Pomara
- Department of Clinical and Experimental Medicine, Section of Forensic Pathology, Ospedale Colonnello D'Avanzo, University of Foggia, Viale degli Aviatori 1, 71100 Foggia, Italy
| | - I. Riezzo
- Department of Clinical and Experimental Medicine, Section of Forensic Pathology, Ospedale Colonnello D'Avanzo, University of Foggia, Viale degli Aviatori 1, 71100 Foggia, Italy
| | - S. Bello
- Department of Clinical and Experimental Medicine, Section of Forensic Pathology, Ospedale Colonnello D'Avanzo, University of Foggia, Viale degli Aviatori 1, 71100 Foggia, Italy
| | - D. De Carlo
- Department of Clinical and Experimental Medicine, Section of Forensic Pathology, Ospedale Colonnello D'Avanzo, University of Foggia, Viale degli Aviatori 1, 71100 Foggia, Italy
| | - M. Neri
- Department of Clinical and Experimental Medicine, Section of Forensic Pathology, Ospedale Colonnello D'Avanzo, University of Foggia, Viale degli Aviatori 1, 71100 Foggia, Italy
| | - E. Turillazzi
- Department of Clinical and Experimental Medicine, Section of Forensic Pathology, Ospedale Colonnello D'Avanzo, University of Foggia, Viale degli Aviatori 1, 71100 Foggia, Italy
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