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Primary Outcome Assessment in a Pig Model of Acute Myocardial Infarction
Published on: October 14, 2016
Can Fetuin A Be Utilized in the Evaluation of Elderly Patients with Acute Myocardial Infarction?
Raluca Tomoaia1,2, Ruxandra Ștefana Beyer1, Dumitru Zdrenghea2,3
1Cardiology Department, Heart Institute "N. Stăncioiu", 400001 Cluj-Napoca, Romania.
Insights
Lower Fetuin-A (FA) levels predict early death and incomplete ST segment resolution (STR) after acute myocardial infarction (AMI) treatment. Measuring FA may improve risk assessment in AMI patients.
Area of Science:
- Cardiology
- Biomarkers
- Acute Myocardial Infarction
Background:
- Lower baseline Fetuin-A (FA) is linked to adverse outcomes post-acute myocardial infarction (AMI).
- The relationship between FA levels, ST segment resolution (STR), and early mortality in AMI remains understudied.
Purpose of the Study:
- To investigate the association between Fetuin-A (FA) levels and early mortality.
- To determine if FA levels correlate with incomplete ST segment resolution (STR) after primary percutaneous coronary intervention (PCI) in AMI patients.
Main Methods:
- 100 AMI patients were divided into sudden cardiac death (SCD) (n=21) and control (n=79) groups.
- Fetuin-A (FA), NT-proBNP, and troponin levels were measured and correlated with early mortality.
- The predictive value of FA for STR was assessed using logistic regression.
Main Results:
- FA levels were significantly lower in patients experiencing SCD (115 vs. 180 ng/mL).
- Lower FA levels (below 175 ng/mL) were associated with a higher mortality rate (30%).
- FA was the only biomarker independently associated with incomplete STR after PCI.
Conclusions:
- Reduced Fetuin-A (FA) levels indicate increased early mortality risk.
- FA measurement, alongside NT-proBNP, troponin, and STR, can enhance risk stratification for AMI patients.
Background:
Lower baseline Fetuin-A (FA) is associated with left ventricular remodeling and cardiovascular death (CVD) at 4 months after acute myocardial infarction (AMI). However, the association between FA levels, incomplete ST segment resolution (STR) following primary percutaneous coronary intervention (PCI) and early mortality in AMI has not been previously studied.
Methods:
We enrolled 100 patients with AMI, which we divided in two groups: 21 patients who suffered sudden cardiac death (SCD) in the first 7 days after PCI and 79 controls. We measured FA, NT-proBNP and troponin levels and correlated them with the occurrence of death in the first week after revascularization. We also tested the cut-off value of FA to determine STR at 90 min after PCI.
Results:
SCD was most frequently caused by pump failure (n = 10, 47.6%) and ventricular arrhythmias (n = 9, 42.5%). Plasma FA levels correlated with NT-proBNP values (r = -0.47, p = 0.04) and were significantly lower in patients presenting SCD (115 (95-175) vs. 180 (105-250) ng/mL, p = 0.03). Among all three biomarkers, FA was the only one associated with incomplete STR after PCI on the multivariate logistic regression (cut-off value of 175 ng/mL, Se = 74%, Sp = 61.1%). Death rate was highest (n = 16/55, 30%) in patients with FA levels below the cut-off value of 175 ng/mL.
Conclusion:
Lower FA is associated with higher early mortality and incomplete STR after primary percutaneous revascularization in patients with AMI. Measurement of FA levels in addition to NT-proBNP, troponin and STR might enable more accurate identification of high-risk patients.
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