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Endothelial Nitric Oxide Level as a Predictor of Coronary Complexity in Patients With Unstable Angina Pectoris

Ahmet Cagdas Acara1, Mustafa Bolatkale2

  • 1Department of Emergency Medicine, Bozyaka Research and Training Hospital, Izmir, Turkey.

The American Journal of the Medical Sciences
|April 20, 2019
PubMed

Insights

Lower nitric oxide levels may predict coronary complexity in unstable angina patients. This finding suggests nitric oxide could be a novel biomarker for guiding treatment decisions between percutaneous coronary intervention and coronary artery bypass graft surgery.

Area of Science:

  • Cardiology
  • Biomarkers
  • Medical Diagnostics

Background:

  • The Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score is an established tool for assessing coronary artery disease complexity.
  • It guides treatment decisions between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery for acute coronary syndrome.
  • The role of nitric oxide (NO) in predicting coronary complexity and guiding treatment in unstable angina pectoris (UAP) requires further investigation.

Purpose of the Study:

  • To compare nitric oxide levels with the SYNTAX score in predicting coronary complexity.
  • To evaluate the association of nitric oxide levels with treatment decisions in patients with unstable angina pectoris.
  • To explore nitric oxide as a potential biomarker for coronary complexity in the emergency department setting.

Main Methods:

  • A study involving 120 patients with unstable angina pectoris and 120 controls.
  • Comparison of nitric oxide levels with SYNTAX scores and treatment choices (coronary angiography, PCI, CABG).
  • Patients were stratified by SYNTAX score (≤18, >18-27, >27) and treatment received.

Main Results:

  • Mean nitric oxide levels were significantly lower in the UAP group compared to controls (P < 0.001).
  • Nitric oxide levels showed a negative correlation with both SYNTAX score (r = -0.227, P = 0.013) and treatment decision (r = -0.498, P < 0.001).
  • Decreased nitric oxide levels were observed with higher SYNTAX scores and in patients undergoing CABG compared to PCI or angiography.

Conclusions:

  • Nitric oxide levels are diminished in patients with unstable angina pectoris.
  • Nitric oxide levels correlate negatively with coronary complexity as assessed by the SYNTAX score.
  • Nitric oxide may serve as a novel biomarker for predicting coronary complexity and informing treatment strategies in UAP patients.
Abstract

Keywords:
Coronary complexityNitric oxidePredictionSYNTAX scoreUnstable angina pectoris

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