The Potential Role of Serum Procalcitonin and Coronary Angiographic Findings in Patients With Acute Coronary Syndromes Evaluated by the SYNTAX Score

Document Type : Original Article

Authors

Department of Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, IR Iran.

Abstract

Background: Inflammation is crucial to the pathophysiology of atherosclerosis and adverse cardiac events. We aimed to investigate serum procalcitonin levels and SYNTAX scores in subgroups of patients with acute coronary syndromes (ACSs).
 
Methods: This cross-sectional study recruited patients admitted for ACSs and categorized them into 3 groups: ST-elevation myocardial infarction (STEMI), non–ST-elevation myocardial infarction (NSTEMI), and unstable angina. Serum procalcitonin and C-reactive protein were measured. The study population underwent percutaneous coronary intervention; then, SYNTAX scores were analyzed.
 
Results: The STEMI (64.86%) and NSTEMI (46.86%) groups were more likely to have positive procalcitonin than the unstable angina group (11.11%) (P =0.002). The mean procalcitonin level was significantly higher in the STEMI group (0.95 ± 0.47) than in the NSTEMI (0.62 ± 0.30) and unstable angina (0.05 ± 0.30) groups (P =0.001). SYNTAX scores were statistically significant in the 3 groups (P =0.004). Multivariate regression analysis indicated significant relationships between procalcitonin levels and ACS subgroups (β = -0.28, P =0.001), triple-vessel disease (β =0.07, P = 0.010), all-cause in-hospital mortality (β = 0.68, P =0.003), and the SYNTAX score (β = 0.72, P =0.004).
 
Conclusions: Serum procalcitonin may be associated with coronary artery disease severity measured with the SYNTAX score. Future studies should evaluate the prognostic accuracy of procalcitonin levels in patients with ACSs. (Iranian Heart Journal 2023; 24(3): 77-84)

Keywords


  1. Puelacher C, Gugala M, Adamson PD, Shah A, Chapman AR, Anand A, et al. Incidence and outcomes of unstable angina compared with non-ST-elevation myocardial infarction. Heart. 2019; 105(18):1423-31.
  2. Bentzon JF, Otsuka F, Virmani R, Falk E. Mechanisms of Plaque Formation and Rupture. Circulation Research. 2014; 114(12):1852-66.
  3. Moriya J. Critical roles of inflammation in atherosclerosis. Journal of Cardiology. 2019; 73(1):22-7.
  4. Kaptoge S, Di Angelantonio E, Lowe G, Pepys M, Thompson S, Collins R, et al. Emerging Risk Factors Collaboration C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis. Lancet. 2010; 375(9709):132-40.
  5. Meisner M. Pathobiochemistry and clinical use of procalcitonin. Clin Chim Acta. 2002; 323(1-2):17-29.
  6. Smith SE, Muir J, Kalabalik-Hoganson J. Procalcitonin in special patient populations: Guidance for antimicrobial therapy. American Journal of Health-System Pharmacy. 2020; 77(10):745-58.
  7. Coşkun A, Aktaş C, Eren ŞH. The Predictive Value of Procalcitonin in the Prognosis of Patients with Acute Coronary Syndrome. Eurasian Journal of Emergency Medicine. 2019; 18(4):185.
  8. Kafkas N, Venetsanou K, Patsilinakos S, Voudris V, Antonatos D, Kelesidis K, et al. Procalcitonin in acute myocardial infarction. Acute cardiac care. 2008; 10(1):30-6.
  9. Ertem AG, Efe TH, Yayla Ç, Akboğa MK, Açar B, Ünal S, et al. The Association Between Serum Procalcitonin Levels and Severity of Coronary Artery Disease Assessed by SYNTAX Score in Patients With Acute Coronary Syndrome. Angiology. 2017; 68(1):40-5.
  10. Remskar M, Horvat M, Hojker S, Noc M. Procalcitonin in patients with acute myocardial infarction. Wien Klin Wochenschr. 2002; 114(5-6):205-10.
  11. Buratti T, Ricevuti G, Pechlaner C, Joannidis M, Wiedermann FJ, Gritti D, et al. Plasma levels of procalcitonin and interleukin-6 in acute myocardial infarction. Inflammation. 2001; 25(2):97-100.
  12. Antman EM, Loscalzo J. Ischemic Heart Disease. In: Loscalzo J, Fauci A, Kasper D, Hauser S, Longo D, Jameson JL, editors. Harrison's Principles of Internal Medicine 21e. New York, NY: McGraw-Hill Education; 2022.
  13. Sianos G, Morel MA, Kappetein AP, Morice MC, Colombo A, Dawkins K, et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention. 2005;1(2):219-27.
  14. Capodanno D, Capranzano P, Di Salvo ME, Caggegi A, Tomasello D, Cincotta G, Miano M, Patané M, Tamburino C, Tolaro S, Patané L. Usefulness of SYNTAX score to select patients with left main coronary artery disease to be treated with coronary artery bypass graft. JACC: cardiovascular interventions. 2009 Aug; 2(8):731-8.
  15. Kurtul A, Elcik D. Procalcitonin is an independent predictor for coronary atherosclerotic burden in patients with stable coronary artery disease. International Journal of Cardiology. 2017; 236:61-4.
  16. Schiopu A, Hedblad B, Engström G, Struck J, Morgenthaler NG, Melander O. Plasma procalcitonin and the risk of cardiovascular events and death: a prospective population‐based study. Journal of internal medicine. 2012; 272(5):484-91.
  17. Ataoğlu HE, Yilmaz F, Uzunhasan I, Cetin F, Temiz L, Döventaş YE, et al. Procalcitonin: a novel cardiac marker with prognostic value in acute coronary syndrome. J Int Med Res. 2010; 38(1):52-61.
  18. Picariello C, Lazzeri C, Chiostri M, Gensini G, Valente S. Procalcitonin in patients with acute coronary syndromes and cardiogenic shock submitted to percutaneous coronary intervention. Internal and Emergency Medicine. 2009; 4(5):403-8.
  19. Sinning CR, Sinning J-M, Schulz A, Schnabel RB, Lubos E, Wild PS, et al. Association of Serum Procalcitonin With Cardiovascular Prognosis in Coronary Artery Disease–Results From the AtheroGene Study–. Circulation Journal. 2011:1102231120-.
  20. Reindl M, Tiller C, Holzknecht M, Lechner I, Henninger B, Mayr A, et al. Association of Myocardial Injury With Serum Procalcitonin Levels in Patients With ST-Elevation Myocardial Infarction. JAMA Network Open. 2020; 3(6):e207030-e.
  21. Sharma YP, Kasinadhuni G, Santosh K, Parashar NK, Sharma R, Bootla D, et al. Prognostic role of procalcitonin in ST-elevation myocardial infarction complicated by cardiogenic shock. Asian Cardiovasc Thorac Ann. 2021; 29(8):751-7.
  22. Brunkhorst FM, Clark AL, Forycki ZF, Anker SD. Pyrexia, procalcitonin, immune activation and survival in cardiogenic shock: the potential importance of bacterial translocation. Int J Cardiol. 1999;72(1):3-10.
  23. Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. New England Journal of Medicine. 2005;352(16):1685-95.