| Objective: To study the relationship between heart-type fattyacid-binding protein (H-FABP) concentration and global registry of acutecoronary events (GRACE) risk score as well as the prognostic value ofHFABP in patients with acute ST-elevation myocardial infarction (STEMI).Methods: From April2010to December2010, a total of sixty patientswith STEMI who was admitted to our hospital within8hours of symptomonset were enrolled in this study. Exclusion criteria: history of myocardialinfarction, chronic heart failure, aortic dissection, serious liver and kidneyfunction abnormal, chronic lung disease, skeletal muscle diseases, massmovement before symptom onset, cerebral infarction, et al. After admission to12hours of symptom onset period, all the patients were collected a bloodsampling to test the concentration every two hours(collect blood sampling in2,4,6,8,10,12hours). Then, H-FABP peak value were found. According tothe peak value, the patients were divided into two groups: A group (theenzymes peak of H-FABP<60ng/ml), B group (the enzymes peak of H-FABP≥60ng/ml). The baseline data were recorded and the GRACE risk score werecalculated. The Pearson correlation analysis were used to analysis therelationship between the H-FABP peak value and GRACE risk score. Aftersufficient preoperative preparation, all patients underwent emergency coronaryangiography (CAG) to diagnose the infarction related artery (IRA).Then, thelesion of IRA was treated by percutaneous transluminal coronary angioplasty(PTCA). Angiography was done after5minutes of stents implanted. CTFC,TMPG were recorded and compared between the two group to find therelationship between the myocardial microcirculation and the H-FABP peakvalue. One month and one year after PCI, the Left ventricular end-diastolic anteroposterior (LVEDD) and left ventricular ejection fraction (LVEF) wererecorded in order to compared the recovery of ventricular function. Besides, atone month and one year later, the major adverse cardiac events (MACE) of thetwo groups patients, including recurrent myocardial infarction, cardiac deaths,malignant arrhythmias, severe heart failure and target vessel revascularizationwere observed.Results:1Baseline dataThere were no significant difference between the two groups about age,sex, smoking, hypertension, hypercholesterolemia, diabetes, blood pressure,heart rates on admission, creatinine, oral drugs used, revascularization time(P>0.05).2Peak time and value of H-FABPThe value of H-FABP in each time were observe. The maximum wasdefined as the peak value. The peak time of H-FABP are found in four to eighthours, and the average of peak value is (59.419±23.125ng/ml).2Relationship between H-FABP concentration and GRACE risk scoreWith the Pearson correlation analysis, we found that the level of H-FABPenzymes peak in peripheral blood of patients with STEMI were positivelycorrelated with GRACE risk score (133.64±55.21). The correlationcoefficient is0.701(P<0.05).3Relationship of myocardial microcirculation and the H-FABP after PCICompared to B group, the proportion of patient with TMPG3grade in Agroup was higher (93.8%vs.89.3%，P>0.05), but there were no significantdifference between the two groups. There were no significant differencebetween the two groups about CTFC of each coronary artery (25.58±6.03vs.26.01±7.21; RCA:23.63±5.98vs.24.39±6.94; LCX:22.02±6.21vs.23.85±7.19, P<0.05).4At one month and one year after PCI, compared the two groups ofheart function and structureAt one month after PCI, echocardiography showed that, compared to B group, LVEF (58.23±7.25%vs.47.46±6.08%) was higher and LVEDD(48.64±6.32vs.54.15±7.21mm) was lower in A group (P<0.05). At one yearafter PCI, heart ultrasound showed that, compared to B group, LVEF(63.19±8.36vs.51.87±7.26%) was higher and LVEDD (46.98±5.98vs.52.49±6.46mm) was lower in A group (P<0.05).5At one month and one year after PCI, compared the two groups ofMACEAt one month after PCI, the incidence of MACE in A group was lessthan that in B group obviously (6.3%vs.35.7%, P<0.05). The incidence ofsevere heart failure was much lower in A group than that in B group (3.1%vs.25.0%，P<0.05). The cases of malignant arrhythmia and cardiac mortality in Agroup were less than B group, but no significant difference was found(P>0.05). There is no significant difference was found between the two groupsabout target vessel revascularization, recurrent myocardial infarction(P>0.05).At one year after PCI, the incidence of MACE in A group was less thanthat in B group obviously (18.8%vs.46.4%，P<0.05). The incidence of severeheart failure was much lower in A group than that in B group (12.5%vs.35.7%，P<0.05). The cases of malignant arrhythmia and cardiac mortality in Agroup were less than B group, but no significant difference was found(P>0.05). There is no significant difference was found between the two groupsabout target vessel revascularization, recurrent myocardial infarction(P>0.05).Conclusion: As the growth of the GRACE risk score, the level ofH-FABP peak value in peripheral blood of patients with STEMI is rise. Therelationship between them is positive correlation. The concentration ofH-FABP can provide additional risk stratification information in STEMI. Thelevel of H-FABP peak value with patients who underwent PCI indicatesdecline of heart function and the rise incidence of MACE. The H-FABPconcentration can provide unique long and short term prognostic informationfor patients with STEMI. |
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