تقييم المؤشرات الحيوية المحتملة قبل وبعد التدخل القسطري للشرايين التاجية

Assessment the Potential Biomarkers before and after Coronary Intervention

Abstract

Background: The etiology of periprocedural myocardial injury and type 4a myocardial infarction (type 4a MI) are multifactorial and may result from percutaneous coronary intervention (PCI) related events or complications. Reperfusion following myocardial ischemia may lead to accelerated myocardial injury and worsening clinical outcomes. One of the most important pathological mechanisms in reperfusion injury is oxidative stress, which is the imbalance between the antioxidant system and the excessive production of reactive oxygen species (ROS), leading to the toxic accumulation of ROS. Ischemia modified albumin (IMA) has also been shown to be elevated in patients after PCI as a result of ischemia-reperfusion injury. The aims are to study the role of biomarkers IMA and Chitenase 3 like protein 1 (CHI3L1) in the complications and consequences after PCI in the coronary artery disease.
Methods: A case control study was carried out at the Karbala Center for Heart Diseases and Surgery and Imam Al – Hassan Al Mujtaba teaching hospital in Kerbala city. The present study involved 120 participants, ranging in age from (29- 84) years. (72) of them underwent elective PCI and (48) underwent diagnostic catheter angiography (CA) serving as a control group. Serum biomarkers level was measured, IMA and CHI3L1 levels were measured using ELISA technique.; Measurement of Lipid profile levels in Human serum was performed using Spectrophotometric Technique.
Results: Results showed that there was a trend of increasing average post-procedure IMA levels with higher Angiographic Lesion Complexity Scores. In Score 0 (absent of complexity) the mean IMA level was (172.1±122.3), Score 1 was (138.0±66.0), Score 2 was (214.4±119.1) and in Score 3 (most complex) IMA level was (530.7±246.6). Post- procedure IMA has a higher sensitivity (84.6%) compared to Pre- procedure IMA (58.6%). This means post- procedure IMA is better at correctly identifying patients who have complex PCI. Both lesion length groups showed an increase in IMA levels following PCI. Lesion length < 30mm: Pre-procedure mean was (167.8±63.2), post- procedure level mean was (251.1±117.9), while Lesion length ≥ 30mm: Pre-procedure mean was (175.7±58.9), post-procedure mean was (296.3±129.1), the increase appears to be greater for longer lesions (≥ 30mm). In contrast to IMA, the trend for CHI3L1 was opposite., Pre- procedure IMA levels in case of Single vessel was (169.5±63.6), and the post- procedure level was (273.4±124.3) While in Single vessel with bifurcation, the Pre- procedure IMA level was (154.5±60.2), and post-procedure IMA was (335.5±166.2). The increase appears to be larger in the group with bifurcation, while might be reflect the degree of the complexity. For CHI3L1 the trend shown that in both groups it was decrease after PCI. In the case of Multi-vessel with bifurcation, the pre- procedure IMA was (190.8±11.8), and the Post- procedure IMA was (332.7±83.4). The increase appears to be similar in both groups, despite the presence of a bifurcation. IMA levels were shown significant Differences when compared to the Pre & Post procedure level in multi-vessel PCI, and a significant difference when compared the Pre & Post procedure level in multi-vessel with bifurcation. The trend for CHI3L1 was markedly different between the two groups and showed a general decreased. Both Pre- procedure IMA and Post- procedure IMA have AUC values around 60%, indicating a moderate ability to distinguish between simple and complex PCI cases.
Conclusion: IMA, along with other clinical factors, could be used to refine risk stratification for patients undergoing procedures, particularly those with complexity expected. The relationship between angiographic lesion complexity, lesion length, number of vessels with bifurcation, and these biomarkers, researchers can develop better strategies to manage ischemia during procedures and potentially improve patient care. IMA levels could be used as a marker to assess the degree of ischemia experienced during PCI, particularly in patients with bifurcations.