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Urinary 11 ‐ Dehydro ‐ Thromboxane B 2 as a Predictor of Acute Myocardial Infarction Outcomes: Results of Leukotrienes and Thromboxane In Myocardial Infarction ( LTIMI ) Study

View Article: PubMed Central - PubMed

ABSTRACT

Background: Urinary 11‐dehydro‐thromboxane (TX)B2 has been described as a potential predictive biomarker of major adverse cardiovascular events (MACEs) in high cardiac risk patients. This part of LTIMI (Leukotrienes and Thromboxane In Myocardial Infarction) study aimed to evaluate the relationship between 11‐dehydro‐TXB2 and MACEs in patients with acute myocardial infarction (AMI).

Methods and results: LTIMI was an observational, prospective study in 180 consecutive patients with AMI type 1 referred for primary percutaneous coronary intervention. On admission and at follow‐up visits (1 month, 1 year), 11‐dehydro‐TXB2 was measured in urinary samples by using high‐performance liquid chromatography–tandem mass spectrometry. The primary outcome was occurrence of composite MACEs during 1‐year after AMI. Left ventricular ejection fraction was assessed in echocardiography on admission and at 1‐year follow‐up. Analyses of 11‐dehydro‐TXB2 (pg/mg creatinine) were performed on log‐transformed data and expressed as median with IQR (Q1–Q3). 11‐Dehydro‐TXB2 level on admission was 7.39 (6.85–8.01) and decreased at 1 month (6.73, 6.27–7.12; P<0.001) and 1‐year follow‐up (6.37, 5.91–6.94; P<0.001). In univariate analysis, baseline 11‐dehydro‐TXB2 was higher in patients with MACEs (n=60; 7.73, 7.07–8.60) compared with those without MACEs (n=119; 7.28, 6.68–7.79; P=0.002). In multivariate regression model, 11‐dehydro‐TXB2 and 3 other variables (diabetes, multivessel disease, and left ventricular ejection fraction) were found to be best 1‐year cumulative MACE predictors with odds ratio for 11‐dehydro‐TXB2 of 1.58 (95% CI 1.095–2.33; P=0.017) and area under the curve (in receiver operating characteristic analysis of 0.8). Baseline 11‐dehydro‐TXB2 negatively correlated with both left ventricular ejection fraction on admission (R=−0.21; P=0.006) and after 1 year (R=−0.346; P<0.001).

Conclusions: 11‐Dehydro‐TXB2 predicts 1‐year cumulative MACEs in AMI patients and provides prognostic information on the left ventricular performance.

No MeSH data available.


Related in: MedlinePlus

Study flow chart. CABG indicates coronary artery bypass graft surgery; NSTEMI, non–ST‐elevation myocardial infarction; PPCI, primary percutaneous coronary intervention; STEMI, ST‐elevation myocardial infarction.
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jah31632-fig-0001: Study flow chart. CABG indicates coronary artery bypass graft surgery; NSTEMI, non–ST‐elevation myocardial infarction; PPCI, primary percutaneous coronary intervention; STEMI, ST‐elevation myocardial infarction.

Mentions: Type of AMI was based on the Joint European Society of Cardiology/American College of Cardiology Foundation/American Heart Association/World Heart Federation Universal Definition15, 16 by 2 cardiologists who were aware of all patients’ clinical data including coronary angiography (CA) findings. Patients naive to antiplatelets were treated with 300 mg non–enteric‐coated aspirin and 300 to 600 mg of clopidogrel in the ambulance or the emergency department. If the patients were taking aspirin on a long‐term basis, they received a lower dose of 75 mg (not enteric coated); the same was true for clopidogrel (75‐mg dose was used). Exclusion criteria were late presentation of AMI (>24 hours from first symptoms), AMI other than type I, cardiogenic shock, history of coronary artery bypass graft surgery (CABG), severe valvular heart disease, symptoms of acute infection, asthma, chronic obstructive pulmonary disease exacerbation, use of antileukotriene medications, chronic kidney disease, liver cirrhosis, malignancy, patient's refusal to participate in the study (<2% of patients), and noncompliance. Patients who received antiplatelet drugs other than aspirin and clopidogrel before or after PCI or were enrolled in any other interventional trial were excluded from the study. The latter was the most common exclusion criterion. A study flow chart is presented on Figure 1.


Urinary 11 ‐ Dehydro ‐ Thromboxane B 2 as a Predictor of Acute Myocardial Infarction Outcomes: Results of Leukotrienes and Thromboxane In Myocardial Infarction ( LTIMI ) Study
Study flow chart. CABG indicates coronary artery bypass graft surgery; NSTEMI, non–ST‐elevation myocardial infarction; PPCI, primary percutaneous coronary intervention; STEMI, ST‐elevation myocardial infarction.
© Copyright Policy - creativeCommonsBy-nc
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5015290&req=5

jah31632-fig-0001: Study flow chart. CABG indicates coronary artery bypass graft surgery; NSTEMI, non–ST‐elevation myocardial infarction; PPCI, primary percutaneous coronary intervention; STEMI, ST‐elevation myocardial infarction.
Mentions: Type of AMI was based on the Joint European Society of Cardiology/American College of Cardiology Foundation/American Heart Association/World Heart Federation Universal Definition15, 16 by 2 cardiologists who were aware of all patients’ clinical data including coronary angiography (CA) findings. Patients naive to antiplatelets were treated with 300 mg non–enteric‐coated aspirin and 300 to 600 mg of clopidogrel in the ambulance or the emergency department. If the patients were taking aspirin on a long‐term basis, they received a lower dose of 75 mg (not enteric coated); the same was true for clopidogrel (75‐mg dose was used). Exclusion criteria were late presentation of AMI (>24 hours from first symptoms), AMI other than type I, cardiogenic shock, history of coronary artery bypass graft surgery (CABG), severe valvular heart disease, symptoms of acute infection, asthma, chronic obstructive pulmonary disease exacerbation, use of antileukotriene medications, chronic kidney disease, liver cirrhosis, malignancy, patient's refusal to participate in the study (<2% of patients), and noncompliance. Patients who received antiplatelet drugs other than aspirin and clopidogrel before or after PCI or were enrolled in any other interventional trial were excluded from the study. The latter was the most common exclusion criterion. A study flow chart is presented on Figure 1.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Urinary 11&#8208;dehydro&#8208;thromboxane (TX)B2 has been described as a potential predictive biomarker of major adverse cardiovascular events (MACEs) in high cardiac risk patients. This part of LTIMI (Leukotrienes and Thromboxane In Myocardial Infarction) study aimed to evaluate the relationship between 11&#8208;dehydro&#8208;TXB2 and MACEs in patients with acute myocardial infarction (AMI).

Methods and results: LTIMI was an observational, prospective study in 180 consecutive patients with AMI type 1 referred for primary percutaneous coronary intervention. On admission and at follow&#8208;up visits (1 month, 1 year), 11&#8208;dehydro&#8208;TXB2 was measured in urinary samples by using high&#8208;performance liquid chromatography&ndash;tandem mass spectrometry. The primary outcome was occurrence of composite MACEs during 1&#8208;year after AMI. Left ventricular ejection fraction was assessed in echocardiography on admission and at 1&#8208;year follow&#8208;up. Analyses of 11&#8208;dehydro&#8208;TXB2 (pg/mg creatinine) were performed on log&#8208;transformed data and expressed as median with IQR (Q1&ndash;Q3). 11&#8208;Dehydro&#8208;TXB2 level on admission was 7.39 (6.85&ndash;8.01) and decreased at 1 month (6.73, 6.27&ndash;7.12; P&lt;0.001) and 1&#8208;year follow&#8208;up (6.37, 5.91&ndash;6.94; P&lt;0.001). In univariate analysis, baseline 11&#8208;dehydro&#8208;TXB2 was higher in patients with MACEs (n=60; 7.73, 7.07&ndash;8.60) compared with those without MACEs (n=119; 7.28, 6.68&ndash;7.79; P=0.002). In multivariate regression model, 11&#8208;dehydro&#8208;TXB2 and 3 other variables (diabetes, multivessel disease, and left ventricular ejection fraction) were found to be best 1&#8208;year cumulative MACE predictors with odds ratio for 11&#8208;dehydro&#8208;TXB2 of 1.58 (95% CI 1.095&ndash;2.33; P=0.017) and area under the curve (in receiver operating characteristic analysis of 0.8). Baseline 11&#8208;dehydro&#8208;TXB2 negatively correlated with both left ventricular ejection fraction on admission (R=&minus;0.21; P=0.006) and after 1 year (R=&minus;0.346; P&lt;0.001).

Conclusions: 11&#8208;Dehydro&#8208;TXB2 predicts 1&#8208;year cumulative MACEs in AMI patients and provides prognostic information on the left ventricular performance.

No MeSH data available.


Related in: MedlinePlus