Acute and Critical Care

Original Article

Cardiology
Evaluation of neopterin levels and kynurenine pathway in patients with acute coronary syndrome: Ibrahim Kember, Sonia Sanajou, Bilge Kilicarslan, Gözde Girgin, Terken Baydar; Acute Crit Care. 2023;38(3):325-332. Published online August 30, 2023; DOI: https://doi.org/10.4266/acc.2023.00024

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Background
Coronary atherosclerosis is the leading cause of coronary artery disease. Several investigations have indicated that tear-sensitive plaques contain macrophages and T cells. Neopterin is an essential cellular immune response biomarker. The main goal of this study was to see if there were any changes in biomarkers like unconjugated pteridines, neopterin, and biopterin, as well as kynurenine pathway enzymes like indoleamine 2,3-dioxygenase (IDO), which catalyzes the rate-limiting step in tryptophan degradation, in patients with the acute coronary syndrome (ACS) caused by angiographic atherosclerosis.
Methods
High-performance liquid chromatography was used to determine the amounts of neopterin, biopterin, and creatinine in urine samples, as well as tryptophan and kynurenine in serum samples. The enzyme-linked immunosorbent assay was used to assess the amounts of neopterin in serum samples. The measured parameters were evaluated between ACS patients and controls.
Results
The measured levels of neopterin, biopterin and the kynurenine to tryptophan ratio reflecting IDO activity, and the specifically known biomarkers such as cardiac troponin, creatine kinase, myoglobin, and natriuretic peptides are statistically higher in ACS patients compared to control subjects. On the other hand, the measured parameters are inadequate to classify the conventional kinds of ACS, ST-elevation- and non-ST-elevation- myocardial infarction.
Conclusions
The study found that determining and using neopterin and IDO parameters as biomarkers in individuals with the ACS can support traditional biomarkers. However, it can be concluded that evaluating pteridine biomarkers solely have no privilege to clinical findings in ACS diagnosis and classification.

Citations

Citations to this article as recorded by

Biomarkers to monitor the prognosis, disease severity, and treatment efficacy in coronary artery disease
Armand N. Yazdani, Michaela Pletsch, Abraham Chorbajian, David Zitser, Vikrant Rai, Devendra K. Agrawal
Expert Review of Cardiovascular Therapy.2023; 21(10): 675. CrossRef
Evaluation of Neopterin as a Neuroinflammatory Marker for Peripheral Neuropathy in Type 2 Diabetic Patients
Israa Abdelmalik Salem, Sura Ahmed Abdulsattar, Haider Fadhil Alrubaye
Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ).2023; 5(1S): S183. CrossRef

Case Report

Cardiology/Endocrinology
Acute Adrenal Insufficiency Associated with Acute Coronary Syndrome: Youngji Kim, Woojin Jung, Inkuk Cho, Seyeol Yang, Ho Han, Jung Hwan Park; Korean J Crit Care Med. 2014;29(3):226-230. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.226

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Abstract PDF: Acute adrenal insufficiency (AAI) in acute coronary syndrome (ACS) patients is rare and may be frequently underestimated as simple ACS, since symptoms of AAI are nonspecific. Physicians should be fully aware of the possibility of occult AAI combined with ACS, if clinical suspicion is high. Herein, we report a rare case of a 67-year-old female patient with concomitant AAI and drug eluting stent fracture-induced ACS. To our knowledge, there have been no case reports of AAI associated with ACS in Korea.

Original Article

Clinical Value of GRACE Score in the Prediction of Mortality in Patients with Acute Coronary Syndrome: Eun Suk Shin, Myung Ho Jeong, Young Hun Lee, Sun Il Ji, So Young Jeong, Ok Hee Lee, Jeong Ja Kang, So Young Yun, Jeong Eun Yoo, Hyung Wook Park, Ju Han Kim, Weon Kim, Young Keun Ahn, Jeong Gwan Cho, Jong Chun Park, Jung Chaee Kang; Korean J Crit Care Med. 2006;21(2):101-108.

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Abstract PDF: BACKGROUND
This study was aimed to evaluate the validity of the Global Registry of Acute Coronary Event (GRACE) in patients with acute coronary syndrome (ACS).
METHODS
One thousand thirty hundred seventy eight patients (63.6+/-12.0 years, 921 male), who were admitted at coronary care unit (CCU) of Chonnam National University Hospital between January 2004 and December 2005, were analyzed. The patients were divided into two groups: the survived group (n=1,298, 871 male, 63.1+/-9.7 years) and the moribund group (n=80, 50 male, 67.4+/-8.5 years). Clinical characteristics, risk factors for atherosclerosis, echocardiographic findings, GRACE score and NT-proBNP were compared between groups.
RESULTS
The overall mortality was 5.8 %, 80 out of 1,378 patients. Mortality was higher in patients with Killip IV (46.7%, 50 out of 107 patients) than Killip II or III and elderly patients more than 80 years (42.7%, 38 out of 89 patients). High Killip class and old age were associated with high mortality (p<0.0001 respectively). Total score of GRACE was elevated in the moribund group (142+/-40.3 vs. 240+/-40.0) and high GRACE score was significant predictor of mortality (p<0.0001, r=0.827). Predictive factors for mortality by multiple logistic regression analysis were GRACE score (OR 1.15, 1.11~1.20 95%CI, p<0.0001) and old age (OR 0.88, 1.14~1.33 95%CI, p<0.001).
CONCLUSIONS
GRACE score is useful predictor for the mortality of ACS at CCU.

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