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Stabil Koroner Arter Hastalığı ile Akut Koroner Sendrom Arasındaki Ayrımda Yeni Bir Biyobelirteç: Tiyoller

Year 2022, Volume: 12 Issue: 4, 526 - 531, 31.07.2022
https://doi.org/10.16899/jcm.981853

Abstract

Amaç: Tiyoller, oksidasyon reaksiyonları ve oksidatif stres durumlarında önemli elementlerdendir. Bu çalışmanın amacı, stabil koroner arter hastalığı hastalarında ve akut koroner sendromlu (AKS) hastalarda bir antioksidan belirteç olan tiyol düzeylerini belirlemektir.

Gereç ve Yöntem: Çalışmaya 210'u AKS, 205'i ise stabil angina pektoris (SAP) tanısı alan hasta dahil edildi. Tiyol gruplarının seviyeleri ve tiyol/disülfid homeostazı spektrofotometrik olarak ölçüldü.

Bulgular: SAP gruplarına kıyasla AKS gruplarında nativ tiyol düzeyleri (332,03±59,84’ e karşı 404,71±67,64, p<0001, toplam tiyol düzeyleri (367,07±64,62’ e karşı 454,28±78,49, p<0001), disulfid (17,52±8,56’ e karşı 24,79±11,17, p<0001, nativ tiyol/ disulfid (5,3±2,6’ e karşı 6,1±2,5, p<005) ve toplam tiyol/disulfid (4,77±2,08’ e karşı 5,36±2, p<003) oranları azalmış olarak tespit edildi.

Sonuç: Tiyol düzeyleri ve tiyol/disülfid oranları AKS’ yi değerlendirmede belirteç olarak kullanılabilir.

Supporting Institution

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References

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  • 2. Badimon L and Vilahur G: Thrombosis formation on atherosclerotic lesions and plaque rupture. J Intern Med. 2014; 276: 618-32.
  • 3. Vogiatzi G, Tousoulis D and Stefanadis C: The role of oxidative stress in atherosclerosis. Hellenic J Cardiol. 2009; 50: 402-9.
  • 4. Bonomini F, Tengattini S, Fabiano A, Bianchi R and Rezzani R: Atherosclerosis and oxidative stress. Histol Histopathol. 2008; 23: 381-90.
  • 5. Stocker R and Keaney JF: Role of oxidative modifications in atherosclerosis. Physiol Rev. 2004 ; 84: 1381-478.
  • 6. Madamanchi NR, Hakim ZS and Runge MS: Oxidative stress in atherogenesis and arterial thrombosis: The disconnect between cellular studies and clinical outcomes. J Thromb Haemost. 2005; 3: 254-67.
  • 7. Leopold JA, Loscalzo J. Oxidative risk for atherothrombotic cardiovascular disease. Free Rad Biol Med. 2009; 47:1673–706.
  • 8. Lubos E, Loscalzo J, Handy D. Glutathione peroxidase-1 in health and disease: From molecular mechanisms to therapeutic opportunities. Antiox Red Sig. 2011; 15:1957–97.
  • 9. Altıparmak IH, Erkuş ME, Sezen H, Demirbag R, Gunebakmaz O, Kaya Z, Sezen Y, Asoglu R, Dedeoglu IH, Neselioglu S, Erel O. The relation of serum thiol levels and thiol/disulphide homeostasis with the severity of coronary artery disease. Kardiol Pol 2016; 74:1346-53.
  • 10. Kiziltunc E, Gok M, Kundi H, Cetin M, Topcuoglu C, Gulkan B, Cicekcioglu H, Ornek E. Plasma thiols and thiol-disulfide homeostasis in patients with isolated coronary artery ectasia. Atherosclerosis 2016; 253: 209-13.
  • 11. Cremers CM, Jakob U. Oxidant sensing by reversible disulfide bond formation. J Biol Chem 2013; 288: 26489-96.
  • 12. Sen CK, Packer L. Thiol homeostasis and supplements in physical exercise. Am J Clin Nutr 2000; 72(2 Suppl): 653-69.
  • 13. Biswas S, Chida AS, Rahman I. Redox modifications of protein–thiols: Emerging roles in cell signaling. Biochem. Pharmacol. 2006; 71: 551–64.
  • 14. Go Y-M, Jones DP. Cysteine/cystine redox signaling in cardiovascular disease. Free Radic. Biol. Med. 2011;50: 495–509.
  • 15. Matteucci E, Giampietro O. Thiol signalling network with an eye to diabetes. Molecules 2010; 15: 8890–903.
  • 16. Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, Bax JJ, Borger MA, Brotons C, Chew DP, Gencer B, Hasenfuss G, Kjeldsen K, Lancellotti P, Landmesser U, Mehilli J, Mukherjee D, Storey RF, Windecker S. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation [in Polish]. Kardiol Pol 2015; 73: 1207–94.
  • 17. Erel O, Neselioglu S. A novel and automated assay for thiol/disulphide homeostasis. Clin Biochem, 2014; 47: 326–32.
  • 18. Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, Bugiardini R, Crea F, Cuisset T, Di Mario C. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013 Oct;34(38):2949-3003.
  • 19. Authors/Task Force Members, Steg, P. G., James, S. K., Atar, D., Badano, L. P., Lundqvist, C. B., ... & Fernandez-Aviles, F. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). Eur Heart J. 2012; 33(20), 2569-619.
  • 20. Sies H. Oxidative stress: oxidants and antioxidants. Exp Physiol 1997; 82(2): 291–5.
  • 21. Nickening G, Harrison DG. The AT-1-type angiotensin receptor in oxidative stress and hypertension part I: oxidative stress and atherogenesis. Circulation 2002; 105: 393–6.
  • 22. Ray R, Shah AM. NADPH oxidase and endothelial cell function. Clin Sci 2005; 109(3):217–26
  • 23. Griendling KK, FitzGerald GA. Oxidative stress and cardiovascular injury part 1: basic mechanisms and in vivo monitoring of ROS. Circulation 2003; 108: 1912–6.
  • 24. Sies H. Total antioxidant capacity: appraisal of a concept. J Nutr 2007;137(6): 1493–5.
  • 25. Wang Y, Chun OK, SongWO. Plasma and dietary antioxidant status as cardiovascular disease risk factors: a reviewof human studies.Nutrients 2013; 5(8):2969–3004.
  • 26. Vaziri ND. Causal link between oxidative stress, inflammation, and hypertension. Iran J Kidney Dis 2008; 2(1):1–10.
  • 27. Cai H, Harrison DG. Endothelial dysfunction in cardiovascular diseases: the role of oxidant stress. Circ Res 2000; 87: 840–4.
  • 28. Majzunova M, Dovinova I, Barancik M, Chan JYH. Redox signaling in pathophysiology of hypertension. J Biomed Sci 2013; 20(1): 69.
  • 29. Ishibashi T.Molecular hydrogen: newantioxidant and anti-inflammatory therapy for rheumatoid arthritis and related diseases. Curr Pharm Des 2013;19(35):6375–81.
  • 30. Ng C-Y, Yusof K, Othman F, Jaarin K. The role of repeatedly heated soybean oil in the development of hypertension in rats: association with vascular inflammation. Int J Exp Pathol 2012; 93(5): 377–87.
  • 31. Steyers III CM, Miller Jr JF. Endothelial dysfunction in chronic inflammatory diseases. Int J Mol Sci 2014;15(7):1324–49.
  • 32. Agan V, Celik H, Eren MA, Agan FZ, Erel O, Neselioglu S, Koyuncu I, Gonel A. An Investigation of Oxidative Stress and Thiol/Disulphide Homeostasis in Graves' Disease. Medicina (Kaunas). 2019 Jun 14;55(6): 275.
  • 33. Koken,T.; Kahraman, A.; Serteser, M. Hemodiyalizin protein karbonil içeri ˘ gi ve sülfidril grupları üzerine etkisi. Türk Nefroloji Diyaliz ve Transplantasyon Dergisi 2001; 10: 64–66.
  • 34. Sen, C.K.; Packer, L. Thiol homeostasis and supplements in physical exercise. Am. J. Clin. Nutr. 2000; 72: 653–69. 35. Morrow JD, Frei B, Longmire AW, Gaziano JM, Lynch SM, Shyr Y, Strauss WE, Oates JA, Roberts LJ 2nd. Increase in circulating products of lipid peroxidation (F2-isoprostanes) in smokers. Smoking as a cause of oxidative damage. N Engl J Med 1995; 332:1198–203
  • 36. Shishehbor MH, Zhang R, Medina H, Brennan ML, Brennan DM, Ellis SG, Topol EJ, Hazen SL. Systemic elevations of free radical oxidation products of arachidonic acid are associated with angiographic evidence of coronary artery disease. Free Radic Biol Med 2006; 41:1678–83.
  • 37. Shishehbor MH, Aviles RJ, Brennan ML, Fu X, Goormastic M, Pearce GL, Gokce N, Keaney JF Jr, Penn MS, Sprecher DL, Vita JA, Hazen SL. Association of nitrotyrosine levels with cardiovascular disease and modulation by statin therapy. JAMA 2003; 289:1675–80.
  • 38. Guzik TJ, Chen W, Gongora MC, Guzik B, Lob HE, Mangalat D, Hoch N, Dikalov S, Rudzinski P, Kapelak B, Sadowski J, Harrison DG. Calcium-dependent NOX5 nicotinamide adenine dinucleotide phosphate oxidase contributes to vascular oxidative stress in human coronary artery disease. J Am Coll Cardiol 2008; 52:1803–09.
  • 39. Walter MF, Jacob RF, Bjork RE, Jeffers B, Buch J, Mizuno Y, Mason RP. Circulating lipid hydroperoxides predict cardiovascular events in patients with stable coronary artery disease: the PREVENT study. J Am Coll Cardiol 2008; 51:1196–202.
  • 40. Espinola-Klein C, Rupprecht HJ, Bickel C, Schnabel R, Genth-Zotz S, Torzewski M, Lackner K, Munzel T, Blankenberg S. Glutathione peroxidase-1 activity, atherosclerotic burden, and cardiovascular prognosis. Am J Cardiol 2007; 99:808–12.
  • 41. Chen YH, Chau LY, Lin MW, Chen LC, Yo MH, Chen JW, Lin SJ. Heme oxygenase-1 gene promotor microsatellite polymorphism is associated with angiographic restenosis after coronary stenting. Eur Heart J 2004; 25:39–47.
  • 42. Dick P, Schillinger M, Minar E, Mlekusch W, Amighi J, Sabeti S, Schlager O, Raith M, Endler G, Mannhalter C, Wagner O, Exner M. Haem oxygenase-1 genotype and cardiovascular adverse events in patients with peripheral artery disease. Eur J Clin Invest 2005; 35:731–7.
  • 43. Elcik D, Kelesoglu S, Yilmaz Y, Cetinkaya Z, Sulaiman J, Yurt R, Neselioglu S, Erel O, Inanc MT, Oguzhan A. Relationship between thiol, disulphide volume and contrast-induced nephropathy in acute coronary syndrome patients treated with percutaneous coronary intervention. Scand J Clin Lab Invest. 2021 May;81(3):173-180.
  • 44. Kundi H, Ates I, Kiziltunc E, Cetin M, Cicekcioglu H, Neselioglu S, Erel O, Ornek E. A novel oxidative stress marker in acute myocardial infarction; thiol/disulphide homeostasis. Am J Emerg Med. 2015 Nov;33(11):1567-71.
  • 45. Morrow DA Sabatine MS, Brennan ML, de Lemos JA, Murphy SA, Ruff CT, Rifai N, Cannon CP, Hazen SL. Concurrent evaluation of novel cardiac biomarkers in acute coronary syndrome: myeloperoxidase and soluble CD40 ligand and the risk of recurrent ischaemic events in TACTICSTIMI 18. Eur Heart J 2008;29:1096–102

A New Biomarker in The Distinction Between Stable Coronary Artery Disease and Acute Coronary Syndrome:Thiols

Year 2022, Volume: 12 Issue: 4, 526 - 531, 31.07.2022
https://doi.org/10.16899/jcm.981853

Abstract

Backraund; Thiols are important elements for oxidation reactions and under oxidative stress. The aim of this study was to determine thiole levels, an antioxidative marker in CAD patients with stable and acute coronary syndrome.
Methods; 210 of the patients included in the study were diagnosed with acute coronary syndrome (ACS), 205 consisted of patients with stable angina pectoris (SAP). Thiol groups levels and thiol/disulphide homeostasis was measured by spectrophotometrically.
Results: Native thiol and total thiol levels, disulfide/natural thiol and disulfide/total thiol ratios were decreased in the ACS groups compared to the SAP groups
Conclusions: Thiol levels and thiol / disulfide ratios can be used as markers to evaluate acute coronary syndrome.

References

  • 1. Pathak LA, Shirodkar S, Ruparelia R and Rajebahadur J: Coronary artery disease in women. Indian Heart J. 2017; 69: 532-8.
  • 2. Badimon L and Vilahur G: Thrombosis formation on atherosclerotic lesions and plaque rupture. J Intern Med. 2014; 276: 618-32.
  • 3. Vogiatzi G, Tousoulis D and Stefanadis C: The role of oxidative stress in atherosclerosis. Hellenic J Cardiol. 2009; 50: 402-9.
  • 4. Bonomini F, Tengattini S, Fabiano A, Bianchi R and Rezzani R: Atherosclerosis and oxidative stress. Histol Histopathol. 2008; 23: 381-90.
  • 5. Stocker R and Keaney JF: Role of oxidative modifications in atherosclerosis. Physiol Rev. 2004 ; 84: 1381-478.
  • 6. Madamanchi NR, Hakim ZS and Runge MS: Oxidative stress in atherogenesis and arterial thrombosis: The disconnect between cellular studies and clinical outcomes. J Thromb Haemost. 2005; 3: 254-67.
  • 7. Leopold JA, Loscalzo J. Oxidative risk for atherothrombotic cardiovascular disease. Free Rad Biol Med. 2009; 47:1673–706.
  • 8. Lubos E, Loscalzo J, Handy D. Glutathione peroxidase-1 in health and disease: From molecular mechanisms to therapeutic opportunities. Antiox Red Sig. 2011; 15:1957–97.
  • 9. Altıparmak IH, Erkuş ME, Sezen H, Demirbag R, Gunebakmaz O, Kaya Z, Sezen Y, Asoglu R, Dedeoglu IH, Neselioglu S, Erel O. The relation of serum thiol levels and thiol/disulphide homeostasis with the severity of coronary artery disease. Kardiol Pol 2016; 74:1346-53.
  • 10. Kiziltunc E, Gok M, Kundi H, Cetin M, Topcuoglu C, Gulkan B, Cicekcioglu H, Ornek E. Plasma thiols and thiol-disulfide homeostasis in patients with isolated coronary artery ectasia. Atherosclerosis 2016; 253: 209-13.
  • 11. Cremers CM, Jakob U. Oxidant sensing by reversible disulfide bond formation. J Biol Chem 2013; 288: 26489-96.
  • 12. Sen CK, Packer L. Thiol homeostasis and supplements in physical exercise. Am J Clin Nutr 2000; 72(2 Suppl): 653-69.
  • 13. Biswas S, Chida AS, Rahman I. Redox modifications of protein–thiols: Emerging roles in cell signaling. Biochem. Pharmacol. 2006; 71: 551–64.
  • 14. Go Y-M, Jones DP. Cysteine/cystine redox signaling in cardiovascular disease. Free Radic. Biol. Med. 2011;50: 495–509.
  • 15. Matteucci E, Giampietro O. Thiol signalling network with an eye to diabetes. Molecules 2010; 15: 8890–903.
  • 16. Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, Bax JJ, Borger MA, Brotons C, Chew DP, Gencer B, Hasenfuss G, Kjeldsen K, Lancellotti P, Landmesser U, Mehilli J, Mukherjee D, Storey RF, Windecker S. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation [in Polish]. Kardiol Pol 2015; 73: 1207–94.
  • 17. Erel O, Neselioglu S. A novel and automated assay for thiol/disulphide homeostasis. Clin Biochem, 2014; 47: 326–32.
  • 18. Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, Bugiardini R, Crea F, Cuisset T, Di Mario C. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013 Oct;34(38):2949-3003.
  • 19. Authors/Task Force Members, Steg, P. G., James, S. K., Atar, D., Badano, L. P., Lundqvist, C. B., ... & Fernandez-Aviles, F. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). Eur Heart J. 2012; 33(20), 2569-619.
  • 20. Sies H. Oxidative stress: oxidants and antioxidants. Exp Physiol 1997; 82(2): 291–5.
  • 21. Nickening G, Harrison DG. The AT-1-type angiotensin receptor in oxidative stress and hypertension part I: oxidative stress and atherogenesis. Circulation 2002; 105: 393–6.
  • 22. Ray R, Shah AM. NADPH oxidase and endothelial cell function. Clin Sci 2005; 109(3):217–26
  • 23. Griendling KK, FitzGerald GA. Oxidative stress and cardiovascular injury part 1: basic mechanisms and in vivo monitoring of ROS. Circulation 2003; 108: 1912–6.
  • 24. Sies H. Total antioxidant capacity: appraisal of a concept. J Nutr 2007;137(6): 1493–5.
  • 25. Wang Y, Chun OK, SongWO. Plasma and dietary antioxidant status as cardiovascular disease risk factors: a reviewof human studies.Nutrients 2013; 5(8):2969–3004.
  • 26. Vaziri ND. Causal link between oxidative stress, inflammation, and hypertension. Iran J Kidney Dis 2008; 2(1):1–10.
  • 27. Cai H, Harrison DG. Endothelial dysfunction in cardiovascular diseases: the role of oxidant stress. Circ Res 2000; 87: 840–4.
  • 28. Majzunova M, Dovinova I, Barancik M, Chan JYH. Redox signaling in pathophysiology of hypertension. J Biomed Sci 2013; 20(1): 69.
  • 29. Ishibashi T.Molecular hydrogen: newantioxidant and anti-inflammatory therapy for rheumatoid arthritis and related diseases. Curr Pharm Des 2013;19(35):6375–81.
  • 30. Ng C-Y, Yusof K, Othman F, Jaarin K. The role of repeatedly heated soybean oil in the development of hypertension in rats: association with vascular inflammation. Int J Exp Pathol 2012; 93(5): 377–87.
  • 31. Steyers III CM, Miller Jr JF. Endothelial dysfunction in chronic inflammatory diseases. Int J Mol Sci 2014;15(7):1324–49.
  • 32. Agan V, Celik H, Eren MA, Agan FZ, Erel O, Neselioglu S, Koyuncu I, Gonel A. An Investigation of Oxidative Stress and Thiol/Disulphide Homeostasis in Graves' Disease. Medicina (Kaunas). 2019 Jun 14;55(6): 275.
  • 33. Koken,T.; Kahraman, A.; Serteser, M. Hemodiyalizin protein karbonil içeri ˘ gi ve sülfidril grupları üzerine etkisi. Türk Nefroloji Diyaliz ve Transplantasyon Dergisi 2001; 10: 64–66.
  • 34. Sen, C.K.; Packer, L. Thiol homeostasis and supplements in physical exercise. Am. J. Clin. Nutr. 2000; 72: 653–69. 35. Morrow JD, Frei B, Longmire AW, Gaziano JM, Lynch SM, Shyr Y, Strauss WE, Oates JA, Roberts LJ 2nd. Increase in circulating products of lipid peroxidation (F2-isoprostanes) in smokers. Smoking as a cause of oxidative damage. N Engl J Med 1995; 332:1198–203
  • 36. Shishehbor MH, Zhang R, Medina H, Brennan ML, Brennan DM, Ellis SG, Topol EJ, Hazen SL. Systemic elevations of free radical oxidation products of arachidonic acid are associated with angiographic evidence of coronary artery disease. Free Radic Biol Med 2006; 41:1678–83.
  • 37. Shishehbor MH, Aviles RJ, Brennan ML, Fu X, Goormastic M, Pearce GL, Gokce N, Keaney JF Jr, Penn MS, Sprecher DL, Vita JA, Hazen SL. Association of nitrotyrosine levels with cardiovascular disease and modulation by statin therapy. JAMA 2003; 289:1675–80.
  • 38. Guzik TJ, Chen W, Gongora MC, Guzik B, Lob HE, Mangalat D, Hoch N, Dikalov S, Rudzinski P, Kapelak B, Sadowski J, Harrison DG. Calcium-dependent NOX5 nicotinamide adenine dinucleotide phosphate oxidase contributes to vascular oxidative stress in human coronary artery disease. J Am Coll Cardiol 2008; 52:1803–09.
  • 39. Walter MF, Jacob RF, Bjork RE, Jeffers B, Buch J, Mizuno Y, Mason RP. Circulating lipid hydroperoxides predict cardiovascular events in patients with stable coronary artery disease: the PREVENT study. J Am Coll Cardiol 2008; 51:1196–202.
  • 40. Espinola-Klein C, Rupprecht HJ, Bickel C, Schnabel R, Genth-Zotz S, Torzewski M, Lackner K, Munzel T, Blankenberg S. Glutathione peroxidase-1 activity, atherosclerotic burden, and cardiovascular prognosis. Am J Cardiol 2007; 99:808–12.
  • 41. Chen YH, Chau LY, Lin MW, Chen LC, Yo MH, Chen JW, Lin SJ. Heme oxygenase-1 gene promotor microsatellite polymorphism is associated with angiographic restenosis after coronary stenting. Eur Heart J 2004; 25:39–47.
  • 42. Dick P, Schillinger M, Minar E, Mlekusch W, Amighi J, Sabeti S, Schlager O, Raith M, Endler G, Mannhalter C, Wagner O, Exner M. Haem oxygenase-1 genotype and cardiovascular adverse events in patients with peripheral artery disease. Eur J Clin Invest 2005; 35:731–7.
  • 43. Elcik D, Kelesoglu S, Yilmaz Y, Cetinkaya Z, Sulaiman J, Yurt R, Neselioglu S, Erel O, Inanc MT, Oguzhan A. Relationship between thiol, disulphide volume and contrast-induced nephropathy in acute coronary syndrome patients treated with percutaneous coronary intervention. Scand J Clin Lab Invest. 2021 May;81(3):173-180.
  • 44. Kundi H, Ates I, Kiziltunc E, Cetin M, Cicekcioglu H, Neselioglu S, Erel O, Ornek E. A novel oxidative stress marker in acute myocardial infarction; thiol/disulphide homeostasis. Am J Emerg Med. 2015 Nov;33(11):1567-71.
  • 45. Morrow DA Sabatine MS, Brennan ML, de Lemos JA, Murphy SA, Ruff CT, Rifai N, Cannon CP, Hazen SL. Concurrent evaluation of novel cardiac biomarkers in acute coronary syndrome: myeloperoxidase and soluble CD40 ligand and the risk of recurrent ischaemic events in TACTICSTIMI 18. Eur Heart J 2008;29:1096–102
There are 44 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Research
Authors

Gökhan Ergün 0000-0003-2340-027X

Şaban Keleşoğlu 0000-0001-6249-9220

Kemal Tekin 0000-0002-6931-3983

Bekir Çalapkorur 0000-0002-9760-1827

Fatih Balcı

Özcan Erel 0000-0002-2996-3236

Salim Neşelioğlu 0000-0002-0974-5717

Deniz Elcik 0000-0003-0992-1415

Early Pub Date June 1, 2022
Publication Date July 31, 2022
Acceptance Date May 20, 2022
Published in Issue Year 2022 Volume: 12 Issue: 4

Cite

AMA Ergün G, Keleşoğlu Ş, Tekin K, Çalapkorur B, Balcı F, Erel Ö, Neşelioğlu S, Elcik D. A New Biomarker in The Distinction Between Stable Coronary Artery Disease and Acute Coronary Syndrome:Thiols. J Contemp Med. July 2022;12(4):526-531. doi:10.16899/jcm.981853