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A study of lipid peroxide and alpha tocopherol in acute myocardial infarction
M K Daga1, K Prabash, R Malhotra
1Dept of Medicine and Biochemistry, Maulana Azad Medical College.
Insights
Reperfusion after acute myocardial infarction increases free radicals, indicated by higher malondialdehyde and lower alpha tocopherol levels. This free radical activity may cause injury, potentially limiting the benefits of reperfusion therapy.
Area of Science:
- Cardiology
- Biochemistry
- Free Radical Biology
Background:
- Acute myocardial infarction (AMI) is a leading cause of mortality worldwide.
- Reperfusion therapy, including thrombolysis with streptokinase, aims to restore blood flow to ischemic heart muscle.
- Oxidative stress and free radical generation are implicated in myocardial injury during ischemia and reperfusion.
Purpose of the Study:
- To investigate the role of free radicals and antioxidants in patients undergoing thrombolysis for acute myocardial infarction.
- To assess changes in malondialdehyde (MDA) as a marker of lipid peroxidation and alpha tocopherol as an antioxidant in successfully versus unsuccessfully reperfused patients.
Main Methods:
- Thirty patients with acute myocardial infarction were treated with streptokinase.
- Reperfusion was assessed using electrocardiography (ECG) criteria (ST segment elevation).
- Serum levels of malondialdehyde (MDA) and alpha tocopherol were measured at the start of treatment (t0) and 3 hours post-treatment (t3).
Main Results:
- In successfully reperfused patients, serum alpha tocopherol significantly decreased (10.03 to 8.60 µg/ml, P < 0.001) and MDA significantly increased (6.86 to 8.4 nmol/ml, P < 0.012).
- In unsuccessfully reperfused patients, no significant changes in alpha tocopherol or MDA levels were observed.
- These findings suggest an increase in free radical activity and a decrease in antioxidant capacity following successful reperfusion.
Conclusions:
- Successful reperfusion following acute myocardial infarction is associated with increased free radical activity.
- The observed increase in malondialdehyde and decrease in alpha tocopherol indicate a state of oxidative stress.
- This free radical-mediated injury may compromise the full benefits of reperfusion therapy in AMI patients.
Abstract:
Thirty patients of acute myocardial infarction proven by electrocardiography (ECG) and enzymes were included in the study. All of them received streptokinase. A single lead showing the largest ST elevation, a proportional value for the shift in ST segment > or = 0.5 was taken as criteria for reperfusion. ECG was recorded at 0 hour, 3 hours and 72 hours. At the start of streptokinase and 3 hours after, marker of free radical activity malondialdehyde (MDA) and antioxidant alpha tocopherol was measured. Mean value of serum alpha tocopherol level at start of streptokinase (t0) 10.03 +/- 2.5 micrograms/ml and at (t3) 3 hours after streptokinase was 8.60 +/- 2.6 micrograms/ml (P < 0.001) and mean value of serum lipid peroxidation level was 6.86 +/- 2.92 nanomol/ml at t(o) and at t3 value was 8.4 +/- 3.88 (P < 0.012) in successfully reperfused patients. In unsuccessful reperfusion group serum alpha tocopherol level at t(o) was 8.89 +/- 2.55 micrograms/ml and at t3 8.23 +/- 2.9 micrograms/ml (p > 0.05). Serum lipid peroxidation level in the same group at t0 was 6.53 +/- 2.26 nanomol/ml and at t3 was 6.29 +/- 2.27 nanomol/ml (p > 0.05). The increase in free radical marker MDA and decrease in one of the important antioxidant alpha tocopherol suggest that free radicals are increased after coronary vessels open up. As a result reperfused patients may be at risk of free radical mediated injury which may deny him the full benefit of reperfusion.