Correlation between ST-T-Segment Changes with Markers of Hemostasis in Patients with Acute Coronary Syndromes

Ehlers, Raila; Büttcher, Eva; Eltzschig, Holger K.; Kazmaier, Silke; Szabo, Sebastian; Helber, Uwe; Hoffmeister, Hans Martin

doi:10.1159/000064683

Cited by 6 publications

(6 citation statements)

References 29 publications

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“…Although the population considered in these studies was heterogeneous in comparison with our patients (patients were taking aspirin, had high levels of troponin I on admission, and determinations of CRP over 6 h of the onset of chest pain were included), from these reports, it was possible to observe a trend to higher CRP values in patients with unstable angina pectoris and ischemic ST-T wave abnormalities compared with patients without ECG changes. Ehlers et al [18] also demonstrated a significant association between high fibrinogen and thrombin-antithrombin III complex levels and patients with ST-T changes.…”

Section: Discussionmentioning

confidence: 99%

“…Two studies evaluated the possible association between serum CRP levels and ECG patterns [17, 18]. Although the population considered in these studies was heterogeneous in comparison with our patients (patients were taking aspirin, had high levels of troponin I on admission, and determinations of CRP over 6 h of the onset of chest pain were included), from these reports, it was possible to observe a trend to higher CRP values in patients with unstable angina pectoris and ischemic ST-T wave abnormalities compared with patients without ECG changes.…”

Section: Discussionmentioning

confidence: 99%

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Relationship between C-Reactive Protein and the Electrocardiographic Pattern on Admission in Patients with Acute Coronary Syndrome

Sánchez

Palacios²,

Pabón³

et al. 2005

Cardiology

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Background: In patients with acute coronary syndrome (ACS), the prevalence of a primary inflammatory pathogenic component of coronary instability, as detectable by elevated C-reactive protein (CRP), varies considerably. The aim of the present study was to assess the prevalence of inflammation in patients with ACS according to the different electrocardiographic (ECG) patterns on admission. Methods: Hundred and thirty-six consecutive patients with the diagnosis of acute myocardial infarction were divided in three groups according to the ECG pattern on admission. Group 1 included 59 patients with ST segment elevation, group 2 included 50 patients with ST depression and/or T wave inversion and group 3 included 27 patients with no ECG changes. CRP was measured on admission in all patients. For the prevalence of inflammation analysis, we used a cutoff value of 3 mg/l. Results: CRP was above cutpoint significantly more often in patients with ST depression and/or T wave inversion (44.1% in group 1, 70% in group 2 and 40.7% in group 3; p = 0.009). Patients with similar ECG pattern and CRP levels above the cutpoint presented a poorer outcome (coronary death, myocardial infarction and recurrence of instability) at one-year follow-up: 54 versus 27% for group 1, 74 versus 27% for group 2 and 45 versus 31% for group 3. Conclusions: Patients with ST depression and/or T wave inversion on admission exhibit a higher prevalence of elevated CRP than those with ST elevation or no ECG changes, suggesting an important heterogeneity of the role of inflammatory triggers of the clinical syndromes of coronary instability.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Relationship between C-Reactive Protein and the Electrocardiographic Pattern on Admission in Patients with Acute Coronary Syndrome

Sánchez

Palacios²,

Pabón³

et al. 2005

Cardiology

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“…The type of anaesthesia may modulate haemostatic activation [8, 14, 22, 23], which is thought to play a causal role in the aetiology of postoperative deep vein thrombosis and pulmonary embolism [8, 12, 13, 16]. Interestingly, in nonsurgical patients with unstable angina, a temporal relationship exists between systemic coagulation activation (fibrinogen level) and ST segment shifts, and intracoronary thrombus formation [7, 8, 24]. Until now, however, no attempt has been made to investigate the possible association of haemostatic activation with peri‐operative myocardial ischaemia and myocardial cell damage.…”

Section: Discussionmentioning

confidence: 99%

“…The latter may be due to activation of platelets and blood coagulation with subsequent formation of intracoronary fibrin and microthrombosis [3–6]. In nonsurgical patients with an unstable pattern of angina, a temporal relationship exists between systemic thrombin activity and ST segment shifts [7, 8]. Because it is well known that major surgery, especially vascular, causes systemic coagulation activation [9–18], peri‐operative hypercoagulation might be associated with peri‐operative myocardial ischaemia and subsequent myocardial cell damage.…”

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confidence: 99%

Association between early postoperative coagulation activation and peri‐operative myocardial ischaemia in patients undergoing vascular surgery

Böttiger¹,

Snyder-Ramos²,

Lapp³

et al. 2005

Anaesthesia

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SummaryWe investigated the association of peri-operative myocardial ischaemia with activation of coagulation and endogenous fibrinolysis in patients undergoing vascular surgery. In 50 patients, continuous Holter monitoring was performed to assess peri-operative myocardial ischaemia and 12-lead electrocardiography was recorded preoperatively and 72 h postoperatively to assess myocardial infarction. Serial blood samples were drawn peri-operatively to determine the concentrations of fibrin monomers (for activation of coagulation), D-dimer (for endogenous fibrinolysis) and cardiac troponin T and I. Patients with myocardial ischaemia showed higher concentrations of fibrin monomers at 48 h, and higher concentrations of D-dimer preoperatively and at 24 and 48 h postoperatively. In patients with peri-operative myocardial ischaemia, strong positive correlations were observed between fibrin monomer and D-dimer concentrations at 15 min and 4 h postoperatively, and cardiac troponins at 15 min and at 4, 24, 48 and 72 h postoperatively. Early postoperative activation of coagulation and fibrinolysis is associated with peri-operative myocardial cell damage among patients who are at risk for, or have a history of, coronary artery disease plus peri-operative myocardial ischaemia. Episodes of peri-operative myocardial ischaemia occur in 18-74% of noncardiac surgery patients with, or at risk of, coronary artery disease [1]. Early postoperative myocardial ischaemia is the single most important predictor of adverse cardiac outcome and is associated with a nine-fold increase in the odds of having cardiac death, nonfatal myocardial infarction or unstable angina [1,2]. Myocardial ischaemia is induced by an increase in myocardial oxygen demand and ⁄ or by a decrease in supply. The latter may be due to activation of platelets and blood coagulation with subsequent formation of intracoronary fibrin and microthrombosis [3][4][5][6]. In nonsurgical patients with an unstable pattern of angina, a temporal relationship exists between systemic thrombin activity and ST segment shifts [7,8]. Because it is well known that major surgery, especially vascular, causes systemic coagulation activation [9][10][11][12][13][14][15][16][17][18], peri-operative hypercoagulation might be associated with peri-operative myocardial ischaemia and subsequent myocardial cell damage. To prevent ischaemic cardiac complications, early administration of antiplatelet therapy (aspirin) after coronary bypass surgery has been investigated, showing reduced rates of ischaemic events not only involving the heart, but also the brain, kidneys and gastrointestinal tract [3]. We designed the present study to investigate the peri-operative time course of serum levels of fibrin monomers and D-dimer, sensitive markers of coagulation and endogenous fibrinolysis, in patients undergoing noncardiac surgery. The

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“…It is a serine protease inhibitor (serpin), which inhibits the formation of thrombin. Stroke is associated with decreased AT-III activity and an increased in thrombin-AT-III complexes [11][12][13]. ApoC-I belongs to the apolipoprotein family.…”

Section: Discussion Of Biomarkersmentioning

confidence: 99%

Mining mass spectra for diagnosis and biomarker discovery of cerebral accidents

Prados

Kalousis

Sanchez³

et al. 2004

Proteomics

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In this paper we try to identify potential biomarkers for early stroke diagnosis using surfaceenhanced laser desorption/ionization mass spectrometry coupled with analysis tools from machine learning and data mining. Data consist of 42 specimen samples, i.e., mass spectra divided in two big categories, stroke and control specimens. Among the stroke specimens two further categories exist that correspond to ischemic and hemorrhagic stroke; in this paper we limit our data analysis to discriminating between control and stroke specimens. We performed two suites of experiments. In the first one we simply applied a number of different machine learning algorithms; in the second one we have chosen the best performing algorithm as it was determined from the first phase and coupled it with a number of different feature selection methods. The reason for this was 2-fold, first to establish whether feature selection can indeed improve performance, which in our case it did not seem to confirm, but more importantly to acquire a small list of potentially interesting biomarkers. Of the different methods explored the most promising one was support vector machines which gave us high levels of sensitivity and specificity. Finally, by analyzing the models constructed by support vector machines we produced a small set of 13 features that could be used as potential biomarkers, and which exhibited good performance both in terms of sensitivity, specificity and model stability.

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Correlation between ST-T-Segment Changes with Markers of Hemostasis in Patients with Acute Coronary Syndromes

Cited by 6 publications

References 29 publications

Relationship between C-Reactive Protein and the Electrocardiographic Pattern on Admission in Patients with Acute Coronary Syndrome

Relationship between C-Reactive Protein and the Electrocardiographic Pattern on Admission in Patients with Acute Coronary Syndrome

Association between early postoperative coagulation activation and peri‐operative myocardial ischaemia in patients undergoing vascular surgery

Mining mass spectra for diagnosis and biomarker discovery of cerebral accidents

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