Pentraxin Level is the Key to Determine Primary Percutaneous Coronary Intervention (PCI) or Fibrinolysis

Author(s): Habib Haybar, Saeed Alipour Parsa, Isa Khaheshi, Zeinab Deris Zayeri*

Journal Name: Cardiovascular & Hematological Disorders-Drug Targets
Formerly Current Drug Targets - Cardiovascular & Hematological Disorders

Volume 19 , Issue 2 , 2019

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Graphical Abstract:


Aims: To examine if pentraxin can help identify patients benefitting most from primary Percutaneous Coronary Intervention (PCI) vs. fibrinolysis.

Methods: Patients with acute ST-Elevation Myocardial Infarction (STEMI) were consecutively recruited from a community center without PCI and a tertiary center with PCI facilities. Left ventricular ejection fraction (LVEF) was determined echocardiographically at baseline and 5 days after the index admission; the difference between two measurements was considered as the magnitude of improvement. We used regression models to test the hypothesis that the magnitude of the advantage of PCI over fibrinolysis in preserving LVEF 5 days after STEMI is modified by pentraxin 3 (PTX3).

Results: The functional advantage (LVEF) of the PCI over fibrinolysis has been determined by PTX3. LVEF was attenuated and even reversed as PTX3 level increased. The primary PCI of the participants with less than 7 PTX3 level, achieved a clinically significant increase in the LVEF as compared to fibrinolysis. At lower levels of PTX3, PCI shows a conspicuous advantage over fibrinolysis in terms of the probability of developing an LVEF <40%.

Conclusion: We demonstrated not only the functional advantage of PCI over fibrinolysis performed within the recommended time frames but also the relative advantage of its relevance to the baseline PTX3 levels. PTX3 can play a role in determining the choice of best therapy. More than 75% of patients with STEMI who have PTX3 levels ≤7 imply the need of PCI.

Keywords: Fibrinolysis, pentraxin, ejection fraction, percutaneous coronary intervention, st-elevation myocardial infarction, cholesterol.

Haybar, H.; Shahrabi, S.; Zayeri, Z.D.; Pezeshki, S. Strategies to increase cardioprotection through cardioprotective chemokines in chemotherapy-induced cardiotoxicity. Int. J. Cardiol., 2018, 269, 276-282.
Haybar, H.; Zayeri, Z.D. The value of using polymorphisms in anti-platelet therapy. Front. Biol., 2017, 12(5), 349-356.
Shimizu, T.; Suzuki, S.; Sato, A.; Nakamura, Y.; Ikeda, K.; Saitoh, S-I.; Misaka, S.; Shishido, T.; Kubota, I.; Takeishi, Y. Cardio-protective effects of pentraxin 3 produced from bone marrow-derived cells against ischemia/reperfusion injury. J. Mol. Cell. Cardiol., 2015, 89, 306-313.
Bonacina, F.; Baragetti, A.; Catapano, A.L.; Norata, G.D. Long pentraxin 3: experimental and clinical relevance in cardiovascular diseases. Mediators Inflamm., 2013, 2013, 725102.
Mantovani, A.; Garlanda, C.; Doni, A.; Bottazzi, B. Pentraxins in innate immunity: from C-reactive protein to the long pentraxin PTX3. J. Clin. Immunol., 2008, 28(1), 1-13.
Garlanda, C.; Maina, V.; Moalli, F.; Cotena, A.; Deban, L.; Doni, A. The long pentraxin PTX3, a soluble pattern recognition receptor involved in innate immunity, inflammation and female fertility. Curr. Immunol. Rev., 2006, 2(4), 319-329.
Jacobs, A.K. Primary angioplasty for acute myocardial infarction-Is it worth the wait? N. Engl. J. Med., 2003, 349(8), 798-800.
Jones, J.; Docherty, A. Non-invasive treatment of ST elevation myocardial infarction. Postgrad. Med. J., 2007, 83(986), 725-730.
Gibbons, R.J.; Holmes, D.R.; Reeder, G.S.; Bailey, K.R.; Hopfenspirger, M.R.; Gersh, B.J. Immediate angioplasty compared with the administration of a thrombolytic agent followed by conservative treatment for myocardial infarction. N. Engl. J. Med., 1993, 328(10), 685-691.
Busk, M.; Maeng, M.; Rasmussen, K.; Kelbaek, H.; Thayssen, P.; Abildgaard, U.; Vigholf, E.; Mortensen, L.S.; Thuesen, L.; Kristensen, S.D.; Nielsen, T.T.; Andersen, H.R. Danami Investigators. The Danish multicentre randomized study of fibrinolytic therapy vs. primary angioplasty in acute myocardial infarction (the DANAMI-2 trial): outcome after 3 years followup2008 2008-05-01 00:00:00. 1259-66 p.
Nielsen, P.H.; Maeng, M.; Busk, M.; Mortensen, L.S.; Kristensen, S.D.; Nielsen, T.T.; Andersen, H.R. DANAMI-2 Investigators. Primary angioplasty versus fibrinolysis in acute myocardial infarction: long-term follow-up in the danish acute myocardial infarction 2 trial. Circulation, 2010, 121(13), 1484-1491.
Andersen, H.R.; Nielsen, T.T.; Rasmussen, K.; Thuesen, L.; Kelbaek, H.; Thayssen, P.; Abildgaard, U.; Pedersen, F.; Madsen, J.K.; Grande, P.; Villadsen, A.B.; Krusell, L.R.; Haghfelt, T.; Lomholt, P.; Husted, S.E.; Vigholt, E.; Kjaergard, H.K.; Mortensen, L.S. DANAMI-2 Investigators. A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction. N. Engl. J. Med., 2003, 349(8), 733-742.
Widimský, P.; Budešínský, T.; Voráč, D.; Groch, L.; Želízko, M.; Aschermann, M.; Branny, M.; St’ásek, J.; Formánek, P. ‘PRAGUE’ Study Group Investigators. Long distance transport for primary angioplasty vs. immediate thrombolysis in acute myocardial infarction. Eur. Heart J., 2003, 24(1), 94-104.
Zijlstra, F.; Beukema, W.P.; van’t Hof, A.W.; Liem, A.; Reiffers, S.; Hoorntje, J.C.; Suryapranata, H.; de Boer, M.J. Randomized comparison of primary coronary angioplasty with thrombolytic therapy in low risk patients with acute myocardial infarction. J. Am. Coll. Cardiol., 1997, 29(5), 908-912.
Pinto, D.S.; Kirtane, A.J.; Nallamothu, B.K.; Murphy, S.A.; Cohen, D.J.; Laham, R.J.; Cutlip, D.E.; Bates, E.R.; Frederick, P.D.; Miller, D.P.; Carrozza, J.P. Jr, Antman, E.M.; Cannon, C.P.; Gibson, C.M. Hospital delays in reperfusion for st-elevation myocardial infarction: implications when selecting a reperfusion strategy. Circulation, 2006, 114(19), 2019-2025.
Namazi, M.H.; Saadat, H.; Safi, M.; Vakili, H.; Alipourparsa, S.; Bozorgmanesh, M.; Haybar, H. Pentraxin 3 is highly specific for predicting anatomical complexity of coronary artery stenosis as determined by the synergy between percutaneous coronary intervention with taxus and cardiac surgery score. Korean Circ. J., 2014, 44(4), 220-226.
Thygesen, K.; Alpert, J.S.; Jaffe, A.S.; Simoons, M.L.; Chaitman, B.R.; White, H.D. Third universal definition of myocardial infarction. Circulation, 2012, 126(16), 2020-2035.
O’Gara, P.T.; Kushner, F.G.; Ascheim, D.D.; Casey, D.E.; Chung, M.K.; de Lemos, J.A.; Ettinger, S.M.; Fang, J.C.; Fesmire, F.M.; Franklin, B.A.; Granger, C.B.; Krumholz, H.M.; Linderbaum, J.A.; Morrow, D.A.; Newby, L.K.; Ornato, J.P.; Ou, N.; Radford, M.J.; Tamis-Holland, J.E.; Tommaso, C.L.; Tracy, C.M.; Woo, Y.J.; Zhao, D.X.; Anderson, J.L.; Jacobs, A.K.; Halperin, J.L.; Albert, N.M.; Brindis, R.G.; Creager, M.A.; DeMets, D.; Guyton, R.A.; Hochman, J.S.; Kovacs, R.J.; Kushner, F.G.; Ohman, E.M.; Stevenson, W.G.; Yancy, C.W. American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 2013, 127(4), e362-e425.
Afilalo, J.; Piazza, N.; Tremblay, S.; Soucy, N.; Huynh, T. Symptom-to-door time in ST segment elevation myocardial infarction: Overemphasized or overlooked? Results from the AMI-McGill study. Can. J. Cardiol., 2008, 24(3), 213-216.
CUSABIO. Human Pentraxin 3 (PTX3) ELISA Kit, Product Manual Wuhan, China: CUSABIO BIOTECH CO., Ltd 2005-2008 [Available from.
Royston, P.; Sauerbrei, W. Multivariable modeling with cubic regression splines: A principled approach. Stata J., 2007, 7(1), 45-70.
Nijland, F.; Kamp, O.; Verhorst, P.M.J.; de Voogt, W.G.; Visser, C.A. Early prediction of improvement in ejection fraction after acute myocardial infarction using low dose dobutamine echocardiography. Heart, 2002, 88(6), 592-596.
Bhatt, D.L. Timely PCI for STEMI - still the treatment of choice. N. Engl. J. Med., 2013, 368(15), 1446-1447.
Keeley, E.C.; Boura, J.A.; Grines, C.L. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet, 2003, 361(9351), 13-20.
Armstrong, P.W.; Gershlick, A.H.; Goldstein, P.; Wilcox, R.; Danays, T.; Lambert, Y.; Sulimov, V. Rosell, Ortiz, F.; Ostojic, M.; Welsh, R.C.; Carvalho, A.C.; Nanas, J.; Arntz, H.R.; Halvorsen, S.; Huber, K.; Grajek, S.; Fresco, C.; Bluhmki, E.; Regelin, A.; Vandenberghe, K.; Bogaerts, K.; Van de Werf, F.; STREAM Investigative Team. Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction. N. Engl. J. Med., 2013, 368(15), 1379-1387.
Taher, T.; Fu, Y.; Wagner, G.S.; Goodman, S.G.; Fresco, C.; Granger, C.B.; Wallentin, L.; van de Werf, F.; Verheugt, F.; Armstrong, P.W. Aborted myocardial infarction in patients with ST-segment elevation: insights from the Assessment of the Safety and Efficacy of a New Thrombolytic Regimen-3 Trial Electro-cardiographic Substudy. J. Am. Coll. Cardiol., 2004, 44(1), 38-43.
Nallamothu, B.K.; Bates, E.R.; Herrin, J.; Wang, Y.; Bradley, E.H.; Krumholz, H.M. NRMI Investigators. Times to treatment in transfer patients undergoing primary percutaneous coronary intervention in the United States: National registry of myocardial infarction (nrmi)-3/4 analysis. Circulation, 2005, 111(6), 761-767.
Gersh, B.J.; Stone, G.W.; White, H.D.; Holmes, D.R., Jr Pharmacological facilitation of primary percutaneous coronary intervention for acute myocardial infarction: Is the slope of the curve the shape of the future? JAMA, 2005, 293(8), 979-786.
Andersen, H.R.; Nielsen, T.T.; Rasmussen, K.; Thuesen, L.; Kelbaek, H.; Thayssen, P.; Abildgaard, U.; Pedersen, F.; Madsen, J.K.; Grande, P.; Villadsen, A.B.; Krusell, L.R.; Haghfelt, T.; Lomholt, P.; Husted, S.E.; Vigholt, E.; Kjaergard, H.K.; Mortensen, L.S. DANAMI-2 Investigators. A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction. N. Engl. J. Med., 2003, 349(8), 733-742.
McNamara, R.L.; Wang, Y.; Herrin, J.; Curtis, J.P.; Bradley, E.H.; Magid, D.J.; Peterson, E.D.; Blaney, M.; Frederick, P.D.; Krumholz, H.M. NRMI Investigators. Effect of door-to-balloon time on mortality in patients with st-segment elevation myocardial infarction. J. Am. Coll. Cardiol., 2006, 47(11), 2180-2186.
Thune, J.J.; Hoefsten, D.E.; Lindholm, M.G.; Mortensen, L.S.; Andersen, H.R.; Nielsen, T.T.; Kober, L.; Kelbaek, H. Danish Multicenter Randomized Study on Fibrinolytic Therapy Versus Acute Coronary Angioplasty in Acute Myocardial Infarction (DANAMI)-2 Investigators. Simple risk stratification at admission to identify patients with reduced mortality from primary angioplasty. Circulation, 2005, 112(13), 2017-2021.
Haybar, H.; Assareh, A.; Ghotbi, Y.; Torabizadeh, M.; Bozorgmanesh, M. Incremental diagnostic value of circulating pentraxin in patients with intermediate risk of coronary artery disease. Heart, 2013, 99(9), 640-648.
Ford, E.S.; Capewell, S. Proportion of the decline in cardiovascular mortality disease due to prevention versus treatment: public health versus clinical care. Annu. Rev. Public Health, 2011, 32, 5-22.
Madan, P.; Elayda, M.A.; Lee, V-V.; Wilson, J.M. Predicting major adverse cardiac events after percutaneous coronary intervention: The Texas Heart Institute risk score. Am. Heart J., 2008, 155(6), 1068-1074.
Scheller, B.; Hennen, B.; Hammer, B.; Walle, J.; Hofer, C.; Hilpert, V.; Winter, H.; Nickenig, G.; Böhm, M. SIAM III Study Group. Beneficial effects of immediate stenting after thrombolysis in acute myocardial infarction. J. Am. Coll. Cardiol., 2003, 42(4), 634-641.
McAllister, D.A.; Halbesma, N.; Carruthers, K.; Denvir, M.; Fox, K.A. GRACE score predicts heart failure admission following acute coronary syndrome. Eur. Heart J. Acute Cardiovasc. Care, 2015, 4(2), 165-171.
Volpi, A.; De Vita, C.; Franzosi, M.G.; Geraci, E.; Maggioni, A.P.; Mauri, F.; Negri, E.; Santoro, E.; Tavazzi, L.; Tognoni, G. Determinants of 6-month mortality in survivors of myocardial infarction after thrombolysis. Results of the GISSI-2 data base. The Ad hoc Working Group of the Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico (GISSI)-2 Data Base. Circulation, 1993, 88(2), 416-429.
Group, T.M.P.R. Risk stratification and survival after myocardial infarction. N. Engl. J. Med., 1983, 309(6), 331-336.
Sheehan, F.H.; Braunwald, E.; Canner, P.; Dodge, H.T.; Gore, J.; Van Natta, P.; Passamani, E.R.; Williams, D.O.; Zaret, B. The effect of intravenous thrombolytic therapy on left ventricular function: a report on tissue-type plasminogen activator and streptokinase from the Thrombolysis in Myocardial Infarction (TIMI Phase I) trial. Circulation, 1987, 75(4), 817-829.
O’Neill, W.; Timmis, G.C.; Bourdillon, P.D.; Lai, P.; Ganghadarhan, V.; Walton, J. Jr., A prospective randomized clinical trial of intracoronary streptokinase versus coronary angioplasty for acute myocardial infarction. N. Engl. J. Med., 1986, 314(13), 812-818.
Sheehan, F.H.; Doerr, R.; Schmidt, W.G.; Bolson, E.L.; Uebis, R.; von Essen, R.; Effert, S.; Dodge, H.T. Early recovery of left ventricular function after thrombolytic therapy for acute myocardial infarction: an important determinant of survival. J. Am. Coll. Cardiol., 1988, 12(2), 289-300.
Juenger, J.; Schellberg, D.; Kraemer, S.; Haunstetter, A.; Zugck, C.; Herzog, W.; Haass, M. Health related quality of life in patients with congestive heart failure: comparison with other chronic diseases and relation to functional variables. Heart, 2002, 87(3), 235-241.
Steding, K.; Engblom, H.; Buhre, T.; Carlsson, M.; Mosén, H.; Wohlfart, B.; Arheden, H. Relation between cardiac dimensions and peak oxygen uptake. J. Cardiovasc. Magn. Reson., 2010, 12(1), 8.
Appleton, C.P.; Galloway, J.M.; Gonzalez, M.S.; Gaballa, M.; Basnight, M.A. Estimation of left ventricular filling pressures using two-dimensional and Doppler echocardiography in adult patients with cardiac disease: additional value of analyzing left atrial size, left atrial ejection fraction and the difference in duration of pulmonary venous and mitral flow velocity at atrial contraction. J. Am. Coll. Cardiol., 1993, 22(7), 1972-1982.
Lundergan, C.F.; Ross, A.M.; McCarthy, W.F.; Reiner, J.S.; Boyle, D.; Fink, C.; Califf, R.M.; Topol, E.J.; Simoons, M.L.; Van Den Brand, M.; Van de Werf, F.; Coyne, K.S. GUSTO-I Angiographic Investigators. Predictors of left ventricular function after acute myocardial infarction: effects of time to treatment, patency, and body mass index: the GUSTO-I angiographic experience. Am. Heart J., 2001, 142(1), 43-50.
Bellandi, F.; Leoncini, M.; Maioli, M.; Toso, A.; Gallopin, M.; Dabizzi, R.P. Markers of myocardial reperfusion as predictors of left ventricular function recovery in acute myocardial infarction treated with primary angioplasty. Clin. Cardiol., 2004, 27(12), 683-688.
Codolosa, J.N.; Valery, B.C.; Pressman, G.S.; Romero-Corral, A.; Sáenz, A.; Morris, D.L.; Figueredo, V.M. Novel predictors of left ventricular systolic function recovery in patients with st elevation myocardial infarction who underwent reperfusion therapy. J. Clin. Exp. Cardiolog., 2013, 4(235), 2.
Menees, D.S.; Peterson, E.D.; Wang, Y.; Curtis, J.P.; Messenger, J.C.; Rumsfeld, J.S.; Gurm, H.S. Door-to-balloon time and mortality among patients undergoing primary PCI. N. Engl. J. Med., 2013, 369(10), 901-909.
Rathore, S.S.; Curtis, J.P.; Chen, J.; Wang, Y.; Nallamothu, B.K.; Epstein, A.J.; Krumholz, H.M. National Cardiovascular Data Registry. Association of door-to-balloon time and mortality in patients admitted to hospital with ST elevation myocardial infarction: National cohort study. BMJ, 2009, 338, b1807.
D’Onofrio, G.; Safdar, B.; Lichtman, J.H.; Strait, K.M.; Dreyer, R.P.; Geda, M.; Spertus, J.A.; Krumholz, H.M. Sex differences in reperfusion in young patients with st-segment-elevation myocardial infarction: results from the VIRGO study. Circulation, 2015, 131(15), 1324-1332.
Otterstad, J.E.; Froeland, G.; St John Sutton, M.; Holme, I. Accuracy and reproducibility of biplane two-dimensional echocardiographic measurements of left ventricular dimensions and function. Eur. Heart J., 1997, 18(3), 507-513.

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Year: 2019
Published on: 05 July, 2019
Page: [160 - 168]
Pages: 9
DOI: 10.2174/1871529X19666181120161810
Price: $65

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