الفهرس 
INTRODUCTION
CLINICAL IMPLICATIONSOnly 14 pages are availabe for public view
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Abstract
Acute coronary syndrome includes non ST segment elevation myocardial infarction (NSTEMI), ST segment elevation myocardial infarction (STEMI) and unstable angina. Many studies reported elevation of serum PTH acute myocardial infarction (AMI) mainly in patients suffered from renal failure. But no one studies the serum PTH level in both AMI subtypes or gets the relation between them and TIMI score or thrombolytic therapy.
The aim of this study is an attempt to find the relation between different forms of acute myocardial infarction and parathyroid hormone.
This study was carried out on 68 AMI patients (59 male patients, 9 female patients) were admitted to ICU, CCU and the cardiology and the internal medicine department in Alexandria Main University Hospital. They were divided into 3 groups: Group I: 34 patients with STMI. Group II: 34 patients with STMI. Group III: 20 healthy subjects of matched age and sex as a control group.
In the present study, the mean serum PTH (47.71±29.49 pg/ml) was significant higher in AMI patients than in control group. The mean serum PTH was higher in STEMI group (67.33±21.10 pg/ml) than in NSTEMI group (28.08±22.96 pg/ml). The mean serum ionized calcium (3.87± 0.91mg/dl) was significantly lower in AMI patients who were evident in STEMI (3.85±1.02 mg/dl) and NSTEMI (3.89±0.77 mg/dl) groups in comparison to control group. The mean serum phosphorus (3.43± 0.48 mg/dl) was significantly higher in AMI patients than in control group; this was evident in STEMI (3.52±0.46 mg/dl) and NSTEMI (3.3±0.50 mg/dl) groups in comparison to control.
In AMI patients, there was a significant positive correlation between serum PTH, serum Phosphorus (P=0.032), FBG (P=0.000), period of hospital stay (P=0.0001) and TIMI score (P=0.001) while a significant negative correlation was detected between serum PTH and ejection fraction (EF) (P=0.025).
In STEMI group, there was a significant negative correlation between serum PTH, serum CKMB (P=0.009) and serum troponin (P=0.001). However, there was a significant positive correlation between serum PTH, period of hospital stay (P=0.003) and TIMI score (P=0.001). The mean serum PTH was higher in the successful thrombolytic therapy group (p < 0.001) with cut off value (≥ 62.7 pg/dl) in detection of successful thrombolytic therapy, which had a sensitivity of 87.5% and specificity of 77.3%. In NSTEMI group, there was a significant positive correlation between serum PTH, serum CKMB (P=0.001), serum troponin (P=0.04) and period of hospital stay (P=0.00). However a significant negative correlation was detected between serum PTH and TIMI score (P=0.004).
In conclusion, the data of the present study provides, for the first time, evidence that a state of PTH selected resistance or a new type of PTH resistance is associated with AMI (sick PTH resistance syndrome). A cutoff value of serum PTH≥ 62.7 pg/ml is the optimal cut-off value for prediction of successful thrombolytic therapy in STEMI. In AMI; high PTH is associated with longer period of hospital stay, lower EF, higher risk of mortality. Such results suggest that PTH not only plays an important predictive role in AMI but also has a beneficial role in reduction of the infarct size. In AMI patients there is a significant positive correlation between serum PTH and FBG, showing impaired fasting glucose during AMI.
STRENGTHS & LIMITATIONS
The major strength of our study; is the relatively large number of subjects and the careful adjustment for a number of possible confounders in the analysis.
There are several limitations to this study:a)Lack of serial measurement of PTH, calcium, phosphorus; so we could not determine the real peak-value and time to peak serum PTH level which might provide additional diagnostic and prognostic information. However, there were no significant differences in the mean serum PTH values within the first 24 hour. In addition, this flexible time interval represents an achievable target in daily practice.
b)Significant difference in age and kidney functions did not well analyzedc)The study is mainly restricted to men, certain age and ethnic group. Despite these limitations, the study expands knowledge on the role of PTH resistance in AMI patients.