A combination of increased Rho kinase activity and N-terminal pro-B-type natriuretic peptide predicts worse cardiovascular outcome in patients with acute coronary syndrome |
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Authors: | Ming Dong James K Liao Bryan Yan Ruijie Li Mang Zhang Cheuk-Man Yu |
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Institution: | 1. Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Peoples'' Republic of China;2. Vascular Medicine Research Unit, Brigham and Women''s Hospital and Harvard Medical School, Boston, MA, United States |
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Abstract: | BackgroundRecent experimental evidence suggests that the Rho/Rho-kinase (ROCK) system may play an important role in the pathogenesis of acute coronary syndrome (ACS) but there are little clinical data. This study examined if ROCK activity is increased in patients with acute coronary syndrome and if ROCK activity predicts long‐term cardiovascular event.MethodBlood samples were collected from 188 patients within 12 h after admission for ACS (53% men; aged 70 ± 13) and from 61 control subject. The main outcome measures were all cause mortality, readmission with ACS or congestive heart failure (CHF) from presentation within around 2 years (mean:14.4 ± 7.2 months; range: 0.5 to 26 months).ResultsROCK activity increased in ST elevation myocardial infarction (STEMI, n = 90) (3.33 ± 0.93), non-STEMI (NSTEMI, n = 68) (3.37 ± 1.04) and unstable angina (UA, n = 30) (2.53 ± 0.59) groups when compared with disease controls (n = 31) (2.06 ± 0.38, all p < 0.001) and healthy controls (n = 30) (1.54 ± 0.43, all p < 0.001). There were 24 deaths, 34 readmissions with ACS and 15 admissions with CHF within 2 years. Patients with a high N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high ROCK activity on admission had a five-fold risk of a cardiovascular event (RR: 5.156; 95% CI: 2.180–12.191) when compared to those with low NT-proBNP and low ROCK activity.ConclusionROCK activity was increased in patients with ACS, particularly in those with myocardial infarction. The combined usage of both ROCK activity and NT-proBNP might identify a subset of ACS patients at particularly high risk. |
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Keywords: | ACS Acute coronary syndrome cTnT Cardiac troponin T ANOVA One-way analysis of variance BH Body height BMI Body mass index BW Body weight CHD Coronary heart disease CHF Congestive heart failure CIHD Coronary ischemic heart disease CPK Creatine phosphokinase CRP C-reactive protein CVA Cardio vascular accidents DBP Diastolic blood pressure DM Diabetes mellitus eGFR Estimated Glomerular Filtration Rate GRACE Global Registry of Acute Coronary Events HDL-C High-density lipoprotein cholesterol HR Heart rate LDL-C Low-density lipoprotein cholesterol LVEF Left ventricular ejection fraction NSTEMI Non-ST elevation myocardial infarction NT-proBNP N-terminal pro-B-type natriuretic peptide PCI Percutaneous coronary intervention ROCK Rho kinase SBP Systolic blood pressure STEMI ST elevation myocardial infarction TC Total cholesterol TG Triglycerides WBC White blood cells UA Unstable angina |
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