Background and objectives; Reactive oxygen species(ROS) can be formed during oxidative stress in acute myocardial infarction (AMI). Thioredoxin 1 (Trx 1) is one of important anti-oxidative systems for overcoming oxidative stress and has been shown to reduce cellular apoptosis via cell survival signal modification. There are scarce data about the clinical and biochemical significance of Trx-1 in AMI.
Methods; We investigated the clinical, angiographical and biochemical significance of serum pre coronary interventional Trx-1 values in the patients with AMI(n=100, males=70, age= 60.38짹13.3[mean짹SD]), especially in patients with ST segment elevation myocardial infarction (STEMI) (n= 64, male=46, age= 60.44짹12.3), who admitted to our emergency triage from July 26, 2006 to June 18, 2010. The design of the assay was performed based on a sandwich Enzyme-Linked Immunosorbent Assay(ELISA). Emergency laboratory including creatine kinase (CK), creatine kinase isoenzyme MB(CK-MB), cardiac Troponin T (cTnT), biochemistry on admission and angiographic variables were analyzed.
Results; PrePCI (percutaneous coronary intervention) TIMI (thrombolysis in myocardial infarction) flow grades of enrolled patients were grade 0(n= 42), 1(n=6), 2(n=19), 3(n=33). PrePCI TIMI grades of STEMI patients were grade 0(n=30), 1(n=3),2(n=13),3(n=18) and TIMI flow grade of post coronary interventional was grade 0(n=1), 1(n=1), 2(n=11), 3(n=87)(especially in STEMI patients, grade 1(n=1),2(n=8),3(n=55)). Killp classification was 1 (n=80), 2 (n= 11), 3(n=5) , 4(n=4), especially in STEMI patients,1(n=48),2(n=8),3(n=4),4(n=3). Initial CK level was 368.3 짹 531.4 U/L and initial CK-MB level 22.92짹33.9 ng/ml, initial cTnT level 0.61짹1.61 ng/ml. Peak CK level was 1951.7 짹 2392.9 U/L and peak CK-MB level 217.84짹 33.9 ng/ml, peak cTnT level 3.11짹5.3 ng/ml. White blood cell count was 11818 짹 4646.86/L and high-sensitivity c-reactive protein level was 1.74 짹 5.5 mg/dl. There were positive linear correlation between prePCI Trx-1 level and initial CK (r =0.281, p = 0.005) and initial cTnT (r=0.453, P<0.001), peak CK(r=0.316, P =0.001) in all AMI patients and the patients with STEMI (Trx-1 and initial CK: r= 0.329, p=0.008; initial cTnT: r= 0.498, p= 0.001; peak CK: r= 0.349 , p= 0.005).
Conclusion; Serum Trx-1 levels and cardiac enzyme levels in patients with AMI and STEMI have positive linear correlation. We can consider plasma Trx-1 levels before undergoing percutaneous coronary intervention as a predictor of myocardial injury in patients with AMI and STEMI. The relationship between prePCI Trx-1 level and outcome should be examined in large, prospective cohort.