Acute coronary insufficiency results when the balance between oxygen need and blood supply to the myocardium is disturbed. In the case of cessation of blood flow, dramatic ultra structural changes occur,
indicating irreversible cell damage. Cell membrane damage is also evident. Damage to the cell membrane results in the release of intracellular contents. Tissue inducing myocardial injury or infarction leads to an increase in the serum concentration of a number of analytes. The change in concentration is referred to as the acute- phase response. Aim of the study: 1- To investigate the existence and possible significance of the acute phase responses of acute phase reactants in patients with QMI, NQMI and UAP. 2- To estimate the change in the levels of serum sialic acids (total & lipid-associated sialic acid) and trace elements in QMI, NQMI and UAP. 3- To monitor the response to treatment in patient with known acute coronary syndromes.
Materials & Methods: In the present study the individual serum proteins (α1-anti trypsin AAT), ceruloplasmin (CP), α2- macroglobulin (AMG), fibrinogen (Fib), complement 3 (C3), and complement 4 (C4) were assayed in 138 patients with acute coronary syndromes (ACS) on day 1, day 3, day 5 and 4 weeks after the attack and in 30 normal subjects as controls. Also the total sialic acid (TSA) and lipid- associated sialic acid (LAS), zinc (Zn), and copper (Cu) were measured in sera of patients on 1st , 3rd , 5th and 28th days post attack and in the controls. Patients were classified into three groups: 1- Patients with Q type of myocardial infarction (QMI). 2- Patients with non Q type of myocardial infarction (NQMI). 3- Patients with unstable angina (UA). Results: The results were compared with those of healthy groups as controls. The results showed a significant elevation in serum AAT, AMG, TSA, and LAS levels on 1st, 3rd and 5th days reaching optimum value on day 3 post infarction in QMI and NQMI patients. Also CP & Fib level showed an increase in concentration on day 1, day 3, and day 5 after the infarction in patients with QMI and NQMI reaching a maximum value on day 5. There was a non significant increase in AAT, Fib, TSA concentration on day 3, and day 5 in patients with UAP, while there was a significant increase on day 1 after the attack. On other hand, the level of CP showed a non significant difference between patients with UAP and healthy subjects.
Furthermore, AMG and LAS level showed no significant difference on day 5 in patients with UAP and significant difference on day1, and day 3 post attack. Complement components C3 and C4 showed lower level in QMI and NQMI patients on admission. Nevertheless, patients with QMI and NQMI started to increase in C3 and C4 concentration on day 3, and day 5 reaching a maximum value on day 3. However there was no significant difference in C3 and C4 levels in patients with UAP. The results of the trace elements, showed a significant decrease in serum zinc (Zn) concentration in QMI and NQMI patients with respect to control group from the first day on with the lowest values being found on the 3rd day after the attack. Also a significant reduce was found on day 1 in patients with UAP, while, there was a non significant decrease on day 3, and day 5 post attack. The present results showed a significant increase in serum copper (Cu) concentration in QMI and NQMI patients on day 1, day 3, and day 5 reaching a maximum level on day 5 after the infarction. There was also significant difference in Cu level in UAP patients on day 1, but the Cu
level showed a non significant difference on day 3 and day 5 post attacks. Conclusion:1- This study indicates that some of acute phase reactants, sialic acids, complements ( C3 and C4 ) and some trace elements (Zn and Cu) levels measured in patients with suspected ischemic heart disease could be a marker of acute coronary syndromes and helpful in identifying patients at high risk. 2- There were a positive correlation between total & lipid-associated sialic acid and some acute-phase proteins in healthy subjects and in patients with acute coronary syndromes 3- The return to almost normal value in follow up cases of patient with QMI, NQMI and UAP on 28th day post attack reflects the response to treatment in patients with known ACS.