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Lower Fetuin-A Predicts Angiographic Impaired Reperfusion and Mortality in ST-Elevation Myocardial Infarction
  1. Nurcan Basar, MD*,
  2. Nihat Sen, MD*,
  3. Selcuk Kanat, MD*,
  4. Mehmet Fatih Ozlu, MD*,
  5. Firat Ozcan, MD*,
  6. Serkan Cay, MD*,
  7. Gonul Erden, MD,
  8. Kumral Ergun Cagli, MD*,
  9. Metin Yildirimkaya, MD,
  10. Orhan Maden, MD*,
  11. Adrian Covic, MD,
  12. Mehmet Kanbay, MD§
  1. From the *Department of Cardiology, Yuksek Ihtisas Education and Research Hospital; †Department of Clinical Biochemistry, Ankara Numune Research and Training Hospital, Ankara, Turkey; ‡Dialysis and Transplantation Center, Parhon University Hospital, Laşi, Romania; and §Department of Medicine, Division of Nephrology, Gulhane Military Medical Academy, Ankara, Turkey.
  1. Received December 23, 2010, and in revised form January 20, 2011.
  2. Accepted for publication January 27, 2011.
  3. Reprints: Mehmet Kanbay, MD, Alparslan Mahallesi, Umit Sokak, No:25/14, Melikgazi, Kayseri, Turkey. E-mail: drkanbay{at}yahoo.com.
  4. The authors have no conflict of interest to declare.

Abstract

Aims Fetuin-A is an anti-inflammatory negative acute-phase glycoprotein, synthesized by the liver. In this study, we aimed to investigate the effects of admission fetuin-A levels on coronary and myocardial blood flow and short- and long-term prognosis in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention.

Methods and Results One hundred eighty consecutive patients admitted with diagnosis of STEMI and 55 healthy age- and sex-matched volunteer controls were enrolled in the study. Patients with STEMI were divided into 2 groups in respect to thrombolysis in myocardial infarction myocardial perfusion grade after primary PCI: with thrombolysis in myocardial infarction myocardial perfusion grade 0-1-2 and thrombolysis in myocardial infarction myocardial perfusion grade 3. Serum levels of fetuin-A were lower in patients with STEMI than in the healthy group subjects. In-hospital and 1-year deaths were significantly higher in patients from the abnormal perfusion group. In-hospital major adverse cardiac event (MACE) and 1-year follow-up MACE also were significantly higher in patients from the abnormal perfusion group. The receiver-operating characteristic analysis indicated an optimal cut point of less than 200 μg/mL, which detects 1-year mortality with a negative predictive value of 95%. The 1-year mortality rate and 1-year MACE were significantly higher in patients with low fetuin-A level as compared with those with high fetuin-A level.

Conclusions Because low-admission fetuin-A levels are associated with impaired coronary flow in STEMI patients undergoing primary percutaneous coronary intervention, admission fetuin-A level detection may be helpful in identifying the patients at a greater risk of poor coronary blood flow and worse short- and long-term prognosis.

Key Words
  • fetuin-A
  • ST segment elevation myocardial infarction
  • percutaneous coronary intervention
  • mortality

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