The association of thiol/disulphide homeostasis with 6-month mortality in patients with acute st-elevation myocardial infarction

Abstract

Aim: Acute ST-elevation myocardial infarction (STMI) is significant determinant of mortality and long-term mortality rates has not changed significantly over the last two decades. Thiols are an important anti-oxidant mechanism in the body, and excessive reactive oxygen species oxidize the thiol into their disulphide forms. Hence, higher level of disulphide is regarded as an indicator of oxidative stress. In the present paper, we sought to investigate any probable relationship between thiol/disulphide homeostasis and 6-month all-cause mortality among STMI survivors.

Material and Methods: 238 consecutive patients with STMI undergoing percutaneous coronary intervension were included.  Blood samples for thiol/disulphide homeostasis were drawn on admission. Syntax I and II scores were calculated using the cineangiographic views and relevant patient demographics.

Results:  6-month mortality occurred in 25 patients (mortality group), while 213 patients remained alive (non-mortality group).  Total thiol, native thiol, disulphide, disulphide/total thiol , disulphide/native thiol and native thiol/total thiol were not different between the mortality and non-mortality groups (p>0.05). Syntax I and II scores were significantly greater in mortality group (26.11±8.06 vs 19.129.80, p=0.029 for Syntax I; 50.1314.59 vs 30.639.79, p<0.001 for Syntax II).

Conclusion: Syntax II score, glomerular filtration rate (GFR) and white blood cell count (WBC) were found to predict 6-month mortality.

Keywords

• thiol disülfide,acute myocardial infarction,mortality

Akut st-elevasyonlu miyokart infarktüsü hastalarinda 6 aylik mortalite ve thiol / disulfid ilişkisi

Abstract

Amaç: Akut ST yükselmeli miyokard infarktüsü (STMI) mortalitenin önemli bir belirleyicisidir ve uzun dönem ölüm oranları son yirmi yılda önemli ölçüde değişmemiştir. Tiyoller vücutta önemli bir antioksidan mekanizmadır ve aşırı reaktif oksijen türleri tiyolü disülfür formlarına okside eder. Bu nedenle daha yüksek seviyedeki disülfid  oksidatif stresin bir göstergesi olarak kabul edilir. Bu yazıda STMI sağ kalanları arasında tiyol / disülfid homeostazı ve 6 aylık tüm nedenlere bağlı ölüm arasındaki olası ilişkiyi araştırmaya çalıştık. 

Gereç ve Yöntemler: Çalışmaya perkütan koroner girişim uygulanan STMI' li 238  hasta dahil edildi. Giriş sırasındaki tiyol / disülfit homeostazı için kan örnekleri alındı. Syntax  I ve II skorları sineanjiyografik görüntüler ve ilgili hasta demografik özellikleri kullanılarak hesaplandı. 

Bulgular:25 hastada (mortalite grubu) 6 aylık takibinde mortalite izlendi, 213 hastada mortalite izlenmedi (mortalite dışı grup) . Total tiyol, nativ  tiyol, disülfid, disülfid / toplam tiyol, disülfid / nativ tiyol ve nativ tiyol / toplam tiyol, mortalite ve mortalite dışı gruplar arasında farklı değildi (p> 0.05). Syntax I ve II skorları mortalite grubunda anlamlı olarak daha yüksekti (26.11 ± 8.06 - 19.12 ± 9.80, Syntax I için p = 0.029; Syntax  II için 50.13 ± 14.59 ve 30.63 ± 9.79, p <0.001).

Sonuç: Syntax II skoru, glomerüler filtrasyon hızı (GFR) ve beyaz kan hücre sayımının (WBC) 6 aylık mortaliteyi öngördüğü bulundu.

Keywords

• thiol-disülfid,akut miyokart infatktüsü,mortalite

References

1. 1. Roger VL, Weston SA, Gerber Y et al. Trends in incidence, severity, and outcome of hospitalized myocardial infarction. Circulation 2010; 121: 863-69
2. 2. Tu JV, Austin PC, Filate WA et al. Outcomes of acute myocardial infarction in Canada. Can J Cardiol 2003; 19: 893-901.
3. 3. Tu JV, Donovan LR, Lee DS et al. Effectiveness of public report cards for improving the quality of cardiac care: the EFFECT study: a randomized trial. JAMA. 2009; 302: 2330-37
4. 4. Jaganjac M, Cipak A, Schaur RJ and Zarkovic N. Pathophysiology of neutrophil-mediated extracellular redox reactions. Front Biosci (Landmark Ed). 2016; 21: 839-55.
5. 5. Young IS and Woodside JV. Antioxidants in health and disease. J Clin Pathol 2001; 54: 176-86.
6. 6. Turell L, Radi R and Alvarez B. The thiol pool in human plasma: the central contribution of albumin to redox processes. Free Radic Biol Med 2013; 65: 244-53
7. 7. Sen CK and Packer L. Thiol homeostasis and supplements in physical exercise. Am J Clin Nutr 2000; 72: 653-69
8. 8. Jones DP and Liang Y. Measuring the poise of thiol/disulfide couples in vivo. Free Radic Biol Med 2009; 47: 1329-38

9. 9. Thygesen K, Alpert JS, Jaffe AS et al. Third universal definition of myocardial infarction. Circulation 2012; 126: 2020-35
10. 10. Quinones MA, Otto CM, Stoddard M et al. Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr 2002; 15: 167-84.
11. 11. Ibanez B, James S, Agewall S et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018; 39: 119-77,
12. 12. Erel O and Neselioglu S. A novel and automated assay for thiol/disulphide homeostasis. Clin Biochem 2014; 47: 326-32
13. 13. Circu ML and Aw TY. Reactive oxygen species, cellular redox systems, and apoptosis. Free Radic Biol Med 2010; 48: 749-62
14. 14. Biswas S, Chida AS and Rahman I. Redox modifications of protein-thiols: emerging roles in cell signaling. Biochem Pharmacol 2006; 71: 551-64
15. 15. Kavakli HS, Sezer AA, Yilmaz H et al. Thiol disulphide homeostasis in patients with acute myocardial infarction (AMI). J Pak Med Assoc 2018; 68: 1631-35.
16. 16. Sivri S, Kasapkara HA, Polat M et al. Dynamic thiol/disulphide homeostasis and its prognostic value in patients with non-ST elevation-acute coronary syndromes. Kardiol Pol 2018; 76: 426-32
17. 17. Kundi H, Ates I, Kiziltunc E et al. A novel oxidative stress marker in acute myocardial infarction; thiol/disulphide homeostasis. Am J Emerg Med 2015; 33: 1567-71
18. 18. Ates I, Kaplan M, Yuksel M et al. Determination of thiol/disulphide homeostasis in type 1 diabetes mellitus and the factors associated with thiol oxidation. Endocrine 2016; 51: 47-51
19. 19. Ates I, Ozkayar N, Inan B et al. Dynamic thiol/disulphide homeostasis in patients with newly diagnosed primary hypertension. J Am Soc Hypertens 2016; 10: 159-66
20. 20. Altiparmak IH, Erkus ME, Sezen H et al. The relation of serum thiol levels and thiol/disulphide homeostasis with the severity of coronary artery disease. Kardiol Pol 2016; 74: 1346-53
21. 21. Rodrigues SD, Batista GB, Ingberman M, Pecoits-Filho R and Nakao LS. Plasma cysteine/cystine reduction potential correlates with plasma creatinine levels in chronic kidney disease. Blood Purif 2012; 34: 231-37
22. 22. Dogru A, Balkarli A, Cetin GY et al. Thiol/disulfide homeostasis in patients with ankylosing spondylitis. Bosn J Basic Med Sci 2016; 16: 187-92
23. 23. Lalwani P, de Souza GK, de Lima DS, Passos LF, Boechat AL and Lima ES. Serum thiols as a biomarker of disease activity in lupus nephritis. PLoS One 2015; 10: e0119947
24. 24. Ates I, Altay M, Yilmaz FM et al. Dynamic thiol/disulfide homeostasis in patients with autoimmune subclinical hypothyroidism. Endocr Res 2016; 41: 343-49
25. 25. Jaswal S, Mehta HC, Sood AK and Kaur J. Antioxidant status in rheumatoid arthritis and role of antioxidant therapy. Clin Chim Acta 2003; 338: 123-29.
26. 26. Frangogiannis NG. The inflammatory response in myocardial injury, repair, and remodelling. Nat Rev Cardiol. 2014; 11: 255-65, doi: 10.1038/nrcardio.2014.28.
27. 27. Falk E, Nakano M, Bentzon JF, Finn AV and Virmani R. Update on acute coronary syndromes: the pathologists' view. Eur Heart J 2013; 34: 719-28
28. 28. Gaasch WH and Zile MR. Left ventricular structural remodeling in health and disease: with special emphasis on volume, mass, and geometry. J Am Coll Cardiol 2011; 58: 1733-40
29. 29. Kundi H, Erel O, Balun A, et al. Association of thiol/disulfide ratio with syntax score in patients with NSTEMI. Scand Cardiovasc J 2015; 49: 95-100
30. 30. Akkus O, Topuz M, Koca H, et al. The relationship between low thiol levels and major adverse cardiovascular events after primary percutaneous coronary intervention in patients with STEMI. Turk Kardiyol Dern Ars. 2018; 46: 248-59