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[Relationship between antithrombin-III value with acute coronary syndrome and preprocedural TIMI flow grade]
Xia Hong1, Pei-ren Shan, Long Hu
1Department of Cardiology, First Affiliated Hospital, Wenzhou Medical College, Wenzhou 325000, China.
Insights
Antithrombin-III (AT-III) levels are significantly lower in acute coronary syndrome (ACS) patients compared to stable angina patients. Lower AT-III activity is associated with poorer preprocedural thrombolysis in myocardial infarction (TIMI) flow, identifying high-risk ACS populations.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Biochemistry
Context:
- Acute coronary syndrome (ACS) poses a significant health burden, necessitating improved diagnostic and prognostic markers.
- Understanding the role of coagulation factors, such as antithrombin-III (AT-III), in ACS pathophysiology is crucial.
Purpose:
- To investigate the differences in AT-III levels between ACS and stable angina pectoris (SAP) patients.
- To examine the correlation between AT-III levels and preprocedural thrombolysis in myocardial infarction (TIMI) flow in ACS patients.
Summary:
- This study found significantly lower AT-III levels in ACS patients compared to SAP patients.
- In ACS subgroups (STEMI, NSTEMI, UAP), reduced AT-III levels correlated with impaired preprocedural TIMI flow (≤2) and, in NSTEMI, with greater culprit lesion stenosis (≥70%).
- Multivariable analysis confirmed AT-III as an independent predictor of compromised preprocedural TIMI flow in ACS.
Impact:
- Findings suggest AT-III levels can help identify high-risk ACS populations early.
- AT-III may serve as a valuable biomarker for assessing coronary artery patency and guiding therapeutic strategies in ACS management.
Objective:
To explore the differences of antiprothrombin-III (AT-III) value in patients with acute coronary syndrome (ACS) and stable angina pectoris (SAP) and examine the association of AT-III value with preprocedural thrombolysis in myocardial infarction (TIMI) flow in ACS patients.
Methods:
This study prospectively included 121 hospitalized ACS patients between February 2011 to June 2011, including ST-segment elevation myocardial infarction (STEMI, n = 50), non-ST segment elevation myocardial infarction (NSTEMI, n = 32) and unstable angina (UAP, n = 39). Meanwhile, 50 SAP cases during the same period were selected as the control group. The AT-III levels were measured by chromogenic substrate method before coronary angiography for all patients.
Results:
(1) The AT-III levels were significantly lower in the ACS patients than those in the SAP cases. (2) In the STEMI subgroup, the AT-III levels were markedly lower in the patients with preprocedural TIMI flow grade ≤ 2 versus those with preprocedural TIMI flow grade 3 (86% ± 11% vs 93% ± 9%, P < 0.05). (3) In the USTEMI/UAP subgroup, the mean levels of AT-III were obviously lower in the patients with preprocedural TIMI flow grade ≤ 2 than those with preprocedural TIMI flow grade 3 (85% ± 8% vs 95% ± 8%, P < 0.01) and were notably lower in the patients with the culprit lesion stenosis ≥ 70% versus those with stenosis < 70% (88% ± 9% vs 94% ± 9%, P < 0.01). (4) Multivariable analysis identified AT-III value as an independent predictor of impaired preprocedural TIMI flow grade of culprit coronary artery in ACS patients.
Conclusion:
The AT-III levels were significantly lower in the ACS patients than those in the SAP patients. The activity of AT-III is positively correlated with the TIMI flow grade in ACS patients. In contrast, the activity of AT-III is negatively correlated with the severity of culprit vessel stenosis in the patients with NSTEMI. Thus AT-III level may be used to distinguish high-risk populations in ACS patients at an early stage.
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