الفهرس 
COVEROnly 14 pages are availabe for public view
 |  | from | 156 |  |  |
| | | from | 156 | | |
Abstract
Coronary artery disease is the leading cause of death among adults and one of the most common reasons for emergency department visits worldwide.
Ischemic heart diseases include a wide spectrum of conditions, ranging from silent ischemia and chronic stable angina (exertion induced angina), through unstable angina (UA), to acute myocardial infarction (AMI). UA occupies the center of this spectrum, causing disability and risk greater than that of chronic stable angina but less than that of AMI
The matrix metalloproteases (MMPs) are a family of zinc-dependent neutral endopeptidases involved in physiological and pathological processes. They play central roles in wound healing, tissue repair and remodelling in response to injury and in the progression of diseases such as arthritis, cancer and cardiovascular disease.
MMP-9 plays a major contributory role in plaque growth and remodelling. MMP-9 levels also contribute to the inter-individual susceptibility to cardiovascular disease and the outcome from ACS
In this regard our study aimed to measure the level of MMP-9 in patients with ACS and to investigate whether serum MMP-9 level can be useful as a diagnostic marker in these patients. The relation of MMP-9 to ACS prognosis in order to assess whether MMP 9 constitutes a marker of future cardiovascular complications was also studied.
For the purpose of the current study, we recruited 120 subjects including: 75 ACS patients group (subdivided in to 25 patients with STEMI, 25 patients with NSTEMI, 25 patients with UA) from the out patient clinic, 25 patients with SA from the out patient clinic and 20 healthy subjects as a control group recruited from relatives of non cardiac patients. Patients with malignancy, infectious diseases, autoimmune diseases, thyroid diseases, liver diseases, renal diseases or any surgical procedure in the preceding 6 months were excluded.
The results of the present study revealed that patients with acute coronary syndrome had statistically higher significant serum MMP-9 level when compared to patients with SA and to the healthy control group. The highest level of MMP-9 was found in STEMI patients followed by NSTEMI then in UA then in SA and the lowest level was found in the healthy control group.
In our study, we demonstrated a strong association between serum level of MMP-9 and subsequent risk of cardiovascular complications namely; ischemic heart disease, congestive heart failure or sudden death.
Furthermore, as regard other cardiovascular risk factors, we found no significant difference between patients having good versus poor disease outcome with respect to age, gender, diabetes, smoking, lipid profile, cardiac enzymes, troponin or number of blood vessels affected
In our study, we demonstrated a strong association between serum level of MMP-9 and subsequent risk of cardiovascular complications namely; ischemic heart disease, congestive heart failure or sudden death.
We found no statistical significant difference in MMP-9 levels among patients clinically at risk of ACS, such as gender, family history, hypertension, obesity, smoking, dyslipidemia or number of blood vessels affected. However, serum MMP-9 level was higher in diabetic than non diabetic patients but did not reach statistical significance.
However, in our study we found a statistically significant positive correlation between MMP-9 serum level and markers of myocardial necrosis such as CK and LDH and between MMP-9 and heart rate.
Therefore, in our study, we constructed a receiver operating characteristic (ROC) curve to define the best cut off value for discriminating MI patients from patients with UA. Our results showed that the best cut off value was 3100ng/dl, with 80% sensitivity, 80% specificity, and accuracy 85%.
Furthermore, by using ROC analysis to assess the prognostic utility of MMP-9 with respect to its ability to predict a poor disease outcome; we could define best cutoff for MMP-9 to 4700 ng/dl. This had a prognostic sensitivity of 71.4%, specificity 83% and accuracy 79%
In conclusion, we found significantly higher level of serum MMP-9 in ACS patients compared to controls. In addition serum MMP-9 level within ACS patients was able to discriminate cases of AMI from cases with UA. It was also able to predict poor disease outcome in terms of disease severity and extent of CAD complications.