Prognostic And Predictive Value Of RANTES In Plasma And Its Receptor CCR5for AMI

Objective:Acute myocardial infarction (AMI) refers to the myocardial ischemia, hypoxia and necrosis due to acute coronary occlusion.It causes severe chest pain, the dynamic changes of myocardial enzymes and ECG clinical features of an acute shortage ofischemic heart disease. AMI has the characteristics of the acute onset dangerous condition, it is the major cause of death of the coronary heart disease. Recent studies have found that apoptosis and inflammatory reaction throughout the whole process of atherosclerosis.On the other hand, find the predictive value of factors on the prognosis of acute myocardial infarction is currently a hot research. Based on the theories above, we can explore the relationship between prognostic value of predictive of patients with acute myocardial infarction and the expression characteristics of peripheral lymphocyte surface CCR5and the level of factor RANTES expression in plasma, through a comparative analysis of patients with acute myocardial infarction and healthy patients.Methods:We recruited98patients with acute myocardial infarction as the experimental group, and50cases of patients with normal coronary angiography as the control group, and collected the patient’s general life information, such as gender, age, lipid levels, smoking history, drinking history, family history, whether hypertension and diabetes. The diagnostic criteria of patients with acute myocardial infarction include the following standard,(1)①the chest pain of ischemic lasting longer than30minutes, rest or sublingual nitroglycerin can not be alleviated;②the dynamic change of ECG:in phase adjacent two or more than two-lead ST-segment arched elevation, precordial≥0.2mv,limb leads≥0.1mV; new-onset left bundle branch block;③serum creatine kinase workers enzyme (CK-MB) or troponin I (cTnl) more than2times than upper limit of normal, and has a dynamic evolution.(2) The time of onset within12hours.(3) infarction related artery(IRA) TIMI fiow≤2.(4) the emergency PCI after the diagnostic of coronary angiography. Coronary artery disease Gensini score:①the level of coronary artery stenosis<25%for1point,26%to50%for2points,51%to75%for4points,76%to90%for8points,91%～99%for16points,100%for32points;②To determine the different coefficients depending on the vascular lesions:the left main five times, left anterior descending artery proximal2.5, the left circumflex artery proximal2.5, the middle of the left anterior descending artery1.5, the front left descending branch of the second diagonal branch0.5, left lateral branches0.5, other1;③Scoring method for coronary artery stenosis degree multiplied by the coefficient of vascular lesions, the last integral credits is the sum for each branch. Exclusion criteria:(1) contrast agent allergy;(2) contraindications for anticoagulation and antiplatelet therapy;(3) In patients with anatomical structure is not suitable for PTCA and stent implantation(including severe calcification, tortuosity, etc.);(4) hepatitis, cancer, acquired immune deficiency syndrome(AIDS), autoimmune disease, recent infection and inflammatory diseases, trauma and recently received surgery, severe hepatic, renal insufficiency.The intervention preoperative and postoperative instantly was extracted5ml of venous blood from patients with acute myocardial infarction and coronary angiography in patients with normal. All patients reviewed in one month again and extracted5ml of venous blood that was measured RANTES concentration with enzyme linked immunosorbent assay (ELISA) and was measured peripheral lymphocytes of CCR5expression characteristics by flow cytometry. Patients with acute myocardial infarction reviewed in one month again after discharge a line out-patient follow-up.The follow-up includes recurrent angina, heart failure (cardiac function II or II above (NYHA classification)), rehospitalization for ACS, cardiac death, nonfatal myocardial infarction, repeat revascularization. SPSS18.0were used for statistical analysis and comparing the levels of the above-mentioned indicators in the groups and between-group differences (P<0.05for differences was statistically significant).Results:(1) There was no significant difference between intervention preoperative and postoperative plasma concentration of RANTES in patients with acute myocardial infarction experimental group (2721.35±205.92vs2700.52±284.61,μg/ml, P>0.05).The plasma level of RANTES of intervention preoperative was significantly higher than the follow-up period(1171.64±267.47, P<0.01). Control group of patients involved preoperative and postoperative and follow-up period, the plasma concentration of RANTES was no significant difference (896.97±41.83vs872.33±59.67vs842.46±56.73, μg/ml, P>0.05).(2) In the experimental group, the plasma concentration of RANTES in the intervention preoperative and postoperative and follow-up period were significantly higher than that in the control group (2721.35±205.92vs896.97±41.83,2700.52±284.61vs872.33±59.67,1171.64±267.47vs842.46±56.73,μg/ml, P<0.01).(3) For the further study the relationship between the level of plasma RANTES concentration and prognostic value of predictive of patients with AMI, we can stratify group again. There was no significant difference between intervention preoperative and postoperative plasma concentration of RANTES in patients with acute myocardial infarction experimental group(2721.35±205.92vs2700.53±845.11, μg/ml, P>0.05).So we can stratify group again in accordance with the preoperative level of plasma RANTES. Group by:according to the preoperative level of RANTES detection it is divided into three groups A, B, C.A group≥3000μg/ml; B group in2000-3000μg/ml; C group<2000μg/ml. The three groups of the patient’s gender, age, lipid levels, smoking history, drinking history, family history, hypertension and diabetes was no significant difference (P>0.05);(4) There was a significant positive correlation between the level of RANTES and the expression of CCR5among AMI groups (r=0.684, P<0.01), the level of RANTES and Gensini score was a significant positive correlation (r=0.756, P<0.01), the expression of CCR5and Gensini score was a significant positive correlation (r=0.743, P<0.01). Through the above analysis, it can show that the higher the level of RANTES and CCR5,the more of degree of Gensini integral, more complex coronary artery lesions.(5) Through the follow-up, the prognosis of patients with acute myocardial infarction major adverse coronary events occur in Table3. There was no significant difference among the three groups in cardiac death, nonfatal myocardial infarction, revascularization, P>0.05.In recurrent angina, heart failure rehospitalization due to ACS, there was significant difference among the three groups, P<0.01.Conclusion: (1) There was a significant positive correlation between the level of RANTES and the expression of CCR5among AMI groups, and significantly higher than the normal control group of patients.(2) According to the above analysis, there is an important prognostic and predictive value of the level of RANTES and its receptor CCR5for AMI.(3) It can show that the higher the level of RANTES and CCR5patients with acute myocardial infarction, the greater likelihood of major adverse cardiovascular events in the short term, the worse prognosis.