The Effects of Percutaneous Coronary Intervention on Biomarkers and Quality of Life in Patients With Chronic Total Coronary Artery Obstruction

Abstract

Background: Chronic total occlusion (CTO) is an angiographic picture of total occlusion without blood flow which is estimated to have lasted at least 3 months. This study attempted to provide an overview of the levels of matrix metalloproteinase-9 (MMP-9), soluble suppression tumorigenicity 2 (sST2), and N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) as remodeling, inflammatory, and atherosclerotic markers, as well as changes in the angina severity in patients with CTO who underwent percutaneous coronary intervention (PCI) compared to those without PCI.Methods: This study is a preliminary report with quasi-experimental design study with a pre-test and post-test approach to compare PCI's effect in CTO patients towards changes in MMP-9, sST2, NT-pro-BNP levels, and changes in the angina severity. Twenty subjects underwent PCI and 20 subjects with optimal medical therapy, who were then assessed at baseline and 8 weeks after intervention. Results:The results of this preliminary report showed that decreased MMP-9 (pre-test: 12.07 ± 1.27 ng/mL vs. post-test: 9.91 ± 5.19 ng/ mL, P = 0.049), sST2 (pre-test: 37.65 ± 20.00 ng/mL vs. post-test: 29.74 ± 15.17 ng/mL, P = 0.026) and NT-pro-BNP (pre-test: 0.63 ± 0.23 ng/mL vs. post-test: 0.24 ± 0.10 ng/mL, P < 0.001) levels were found after 8 weeks of PCI compared to those without such intervention. The levels of NT-pro-BNP were lower in the PCI group (0.24 ± 0.10 ng/mL) than in the non-PCI group (0.56 ± 0.23 ng/mL; P < 0.001). Moreover, there was an improvement of angina severity in PCI group than without PCI (P < 0.039). Conclusions:Although this preliminary report found a significant decrease in MMP-9, NT-pro-BNP, and sST2 levels in CTO patients who had undergone PCI compared to those without PCI, as well as improved angina severity in these patients, this study still has limitations. The number of samples was so small that similar studies with larger sample sizes or multicenter investigations are required to deliver more trustworthy and useful results. Nevertheless, we encourage this study as a preliminary baseline for further studies in the future.

Transcoronary Gradients of Mechanosensitive MicroRNAs as Predictors of Collateral Development in Chronic Total Occlusion

“…Furthermore, the association of diastolic dysfunction and prolonged symptom duration with the CTO patients reflects the persistent nature of the condition and its effect on cardiac function. Elevations in hs-Troponin and MMP-2 within the CTO patients point to persistent myocardial stress and structural heart remodeling, shedding light on the active pathobiology of CTOs and indicating a continuous myocardial response to long-term ischemic injury [22,23]. The lower levels of VEGF observed in the CAD and CTO patients might indicate a compromised angiogenic response, which is essential for the collateral vessel development and represents a potential focus for therapeutic intervention in CTO treatment [24][25][26].…”

Frequency of multi-vessel disease and its association with N Terminal-Pro Brain Natriuretic Peptide Levels among patients with First ST-Elevation Myocardial Infarction.

“…Among its various activities are sympathetic nerve activation, natriuresis, vasodilation, and inhibition of the renin-angiotensin-aldosterone system. 4 BNP and NT proBNP have been shown to offer predictive information on acute coronary syndrome (ACS) 5 , and they seem to be associated to the severity of CAD in these patients and have demonstrated an association with multivessel disease, poor TIMI flow, as well as are markers of coronary disease extension. 6 Despite the worldwide use of NT-proBNP testing, prospective data that examine its role in the diagnosis of multivessel disease in ACS has been limited in our population.…”