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Value of Alkaline Phosphatase in Predicting the Extent and Severity of Coronary Artery Disease in Acute Myocardial Infarction

Year 2017, Volume: 20 Issue: 2, 91 - 97, 01.08.2017

Abstract

Introduction:
The
serum alkaline phosphatase (ALP) level has been shown to be a prognostic factor
in stable coronary artery disease (CAD) and acute myocardial infarction (AMI)
by its promoting effect on vascular calcification. The objectives of this study
were to investigate serum ALP levels and to determine their value in predicting
the extent and severity of CAD in patients with AMI.



Patients
and Methods:
A total of 200 patients with AMI were included in this
study. Patients with serum ALP levels higher than 120 mg/dL were classified as
elevated ALP group. The extent and severity of CAD was assessed using Gensini
score and number of vessel disease. Patients with a Gensini score greater than
40 were included in advanced CAD group.



Results: There was
no relationship between the ALP level and the Gensini score in study
population. Patients were grouped according to the Gensini score (Gensini
scores ≤ 40 and > 40). There was no difference between the groups in terms
of ALP levels. However, ALP levels were significantly higher in diabetic
patients and in patients with non—ST-segment elevation myocardial infarction
(NSTEMI). Parathormone levels and neutrophil counts were significantly higher
in the advanced CAD group.



Conclusion: ALP levels do not indicate
the extent and severity of CAD in patients with AMI. However, these levels are
higher in diabetic patients and in patients with NSTEMI than in patients with
ST-segment elevation myocardial infarction. Higher parathormone levels and
neutrophil counts are related to the extent and severity of CAD in patients
with AMI.

References

  • 1. Tavazzi L. Clinical epidemiology of acute myocardial infarction. Am Heart J 1999;138:S48-54.
  • 2. Huang G, Zhao JL, Du H, Lan XB, Yin YH. Coronary score adds prognostic information for patients with acute coronary syndrome. Circ J 2010;74:490-5.
  • 3. Detrano R, Guerci AD, Carr JJ, Bild DE, Burke G, Folsom AR, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med 2008;358:1336-45.
  • 4. Schoppet M, Shanahan CM. Role for alkaline phosphatase as an inducer of vascular calcification in renal failure? Kidney Int 2008;73:989 -91.
  • 5. Johnson RC, Leopold JA, Loscalzo J. Vascular calcification: pathobiological mechanisms and clinical implications. Circ Res 2006;99:1044-59.
  • 6. Palmer SC, Hayen A, Macaskill P, Pellegrini F, Craig JC, Elder GJ, et al. Serum levels of phosphorus, parathyroid hormone, and calcium and risks of death and cardiovascular disease in individuals with chronic kidney disease: a systematic review and meta analysis. JAMA 2011;305:1119-27.
  • 7. Regidor DL, Kovesdy CP, Mehrotra R, Rambod M, Jing J, McAllister CJ, et al. Serum alkaline phosphatase predicts mortality among maintenance hemodialysis patients. J Am SocNephrol 2008;19:2193-203.
  • 8. Dhingra R, Sullivan LM, Fox CS, Wang TJ, D’Agostino RB Sr, Gaziano JM, et al. Relations of serum phosphorus and calcium levels to the incidence of cardiovascular disease in the community. Arch Intern Med 2007;167:879-85.
  • 9. Tonelli M, Curhan G, Pfeffer M, Sacks F, Thadhani R, Melamed ML, et al. Relation between alkaline phosphatase, serum phosphate and all-cause or cardiovascular mortality. Circulation 2009;120:1784-92.
  • 10. Park JB, Kang DY, Yang HM, Cho HJ, Park KW, Lee HY, et al. Serum alkaline phosphatase is a predictor of mortality, myocardial infarction, or stent thrombosis after implantation of coronary drug-eluting stent. Eur Heart J 2013;34:920-31.
  • 11. Sahin I, Karabulut A, Gungor B, Avci II, Okuyan E, Kizkapan F, et al. Correlation between the serum alkaline phosphatase level and the severity of coronary artery disease. Coron Artery Dis 2014;25:349-52.
  • 12. Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol 1983;51:606.
  • 13. Ringqvist I, Fisher LD, Mock M, Davis KB, Wedel H, Chaitman BR, et al. Prognostic value of angiographic indices of coronary artery disease from the Coronary Artery Surgery Study (CASS). J Clin Invest 1983;71:1854-66.
  • 14. Scialla JJ, Wolf M. Roles of phosphate and fibroblast growth factor 23 in cardiovascular disease. Nat Rev Nephrol 2014;10:268-78.
  • 15. Gonzalez-Parra E, Rojas-Rivera J, Tuñón J, Praga M, Ortiz A, Egido J. Vitamin D receptor activation and cardiovascular disease. Nephrol Dial Transplant 2012;(27 Suppl 4):iv17-21.
  • 16. O’Neill WC. Pyrophosphate, alkaline phosphatase, and vascular calcification. Circ Res 2006;99:e2.
  • 17. Kawaguchi H, Mori T, Kawano T, Kono S, Sasaki J, Arakawa K. Band neutrophil count and the presence and severity of coronary atherosclerosis. Am Heart J 1996;132:9-12.
  • 18. Gibson PH, Cuthbertson BH, Croal BL, Rae D, El-Shafei H, Gibson G, et al. Usefulness of neutrophil/lymphocyte ratio as predictor of new-onset atrial fibrillation after coronary artery bypass grafting. Am J Cardiol 2010;105:186-91.
  • 19. Chen H, Li X, Yue R, Ren X, Zhang X, Ni A. The effects of diabetes mellitus and diabetic nephropathy on bone and mineral metabolism in T2DM patients. Diabetes Res Clin Pract 2013;100:272-6.
  • 20. Suzuki K, Ishida H, Takeshita N, Taguchi Y, Sugimoto C, Nosaka K, et al. Circulating levels of tartrate-resistant acid phosphatase in rat models of non-insulin-dependent diabetes mellitus. J Diabetes Complications 1998;12:176-80.
  • 21. Kendrick J, Targher G, Smits G, Chonchol M. 25-Hydroxyvitamin D deficiency is independently associated with cardiovascular disease in the Third National Health and Nutrition Examination Survey. Atherosclerosis 2009;205:255-60.
  • 22. Herrmann M, Sullivan DR, Veillard AS, McCorquodale T, Straub IR, Scott R, et al.; FIELD Study Investigators. Serum 25-hydroxyvitamin D: a predictor of macrovascular and microvascular complications in patients with type 2 diabetes. Diabetes Care 2015;38:521-8.
  • 23. Forouhi NG, Ye Z, Rickard AP. Circulating 25-hydroxyvitamin D concentration and the risk of type 2 diabetes in individuals with prediabetes but not with normal glucose tolerance. Diabetologia 2012;55:2173-82.
  • 24. Roe MT, Messenger JC, Weintraub WS, Cannon CP, Fonarow GC, Dai D, et al. Treatments, trends, and outcomes of acute myocardial infarction and percutaneous coronary intervention. J Am Coll Cardiol 2010;56:254-63.
  • 25. Armstrong PW, Fu Y, Chang WC, Topol EJ, Granger CB, Betriu A, et al. Acute coronary syndromes in the GUSTO-IIb trial: prognostic insights and impact of recurrent ischemia. The GUSTO-IIb Investigators. Circulation 1998;98:1860-8.
  • 26. Behar S, Haim M, Hod H, Kornowski R, Reicher-Reiss H, Zion M, et al. Long-term prognosis of patients after a Q wave compared with a non-Q wave first acute myocardial infarction. Data from the SPRINT Registry. Eur Heart J 1996;17:1532-27.
  • 27. Yan AT, Tan M, Fitchett D, Chow CM, Fowlis RA, McAvinue TG, et al; Canadian Acute Coronary Syndromes Registry Investigators. One-year outcome of patients after acute coronary syndromes (from the Canadian Acute Coronary Syndromes Registry). Am J Cardiol 2004;94:25-9.

Akut Miyokart İnfarktüsünde Koroner Arter Hastalığının Yaygınlığını ve Ciddiyetini Tahmin Etmede Alkalen Fosfatazın Değeri

Year 2017, Volume: 20 Issue: 2, 91 - 97, 01.08.2017

Abstract

Giriş: Serum alkalen fosfataz (ALP) seviyesi, vasküler kalsifikasyon üzerine olan
tetikleyici etkisinden dolayı akut miyokart infarktüsü (AMİ)’nde ve stabil
koroner arter hastalığı (KAH)’nda prognostik bir faktör olarak gösterilmiştir.
Çalışmanın amacı, AMİ hastalarında serum ALP seviyelerini araştırmak ve KAH’ın
yaygınlığı ve ciddiyetini tahmin etmedeki değerini saptamaktır.



Hastalar ve
Yöntem:
Bu çalışmaya AMİ geçiren toplam 200 hasta dahil edildi.
Serum ALP düzeyleri 120 mg/dL’den yüksek olanlar, yükselmiş ALP grubu olarak
tanımlandı. KAH’ın yaygınlığı ve ciddiyeti, Gensini skoru ve hasta damar sayısı
ile değerlendirildi. Gensini skoru 40’ın üzerinde olan hastalar, ilerlemiş KAH
grubuna dahil edildi.



Bulgular: Çalışma popülasyonunda ALP düzeyi ve Gensini skoru arasında ilişki yoktu.
Hastalar Gensini skorlarına göre gruplandırıldı (Gensini skoru ≤ 40 ve Gensini
skoru > 40). Gruplar arasında ALP düzeyi açısından fark yoktu. Bununla
birlikte, ALP düzeyleri diyabetik hastalarda ve 
ST elevasyonsuz miyokart infarktüsü (NSTEMİ) olan hastalarda anlamlı
derecede daha yüksekti. Parathormon düzeyleri ve nötrofil sayıları, ilerlemiş
KAH grubunda anlamlı olarak yüksek bulundu.



Sonuç: ALP düzeyi, AMİ’li
hastalarda KAH yaygınlığı ve ciddiyetini göstermemektedir. Bununla birlikte ALP
düzeyleri, diyabetik hastalarda ve ST elevasyonlu miyokart infarktüsü (STEMİ)
hastalarıyla kıyaslandığında NSTEMİ hastalarında daha yüksektir. Yüksek
parathormon düzeyi ve nötrofil sayısı, AMİ’de KAH yaygınlığı ve ciddiyeti ile
ilişkilidir.

References

  • 1. Tavazzi L. Clinical epidemiology of acute myocardial infarction. Am Heart J 1999;138:S48-54.
  • 2. Huang G, Zhao JL, Du H, Lan XB, Yin YH. Coronary score adds prognostic information for patients with acute coronary syndrome. Circ J 2010;74:490-5.
  • 3. Detrano R, Guerci AD, Carr JJ, Bild DE, Burke G, Folsom AR, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med 2008;358:1336-45.
  • 4. Schoppet M, Shanahan CM. Role for alkaline phosphatase as an inducer of vascular calcification in renal failure? Kidney Int 2008;73:989 -91.
  • 5. Johnson RC, Leopold JA, Loscalzo J. Vascular calcification: pathobiological mechanisms and clinical implications. Circ Res 2006;99:1044-59.
  • 6. Palmer SC, Hayen A, Macaskill P, Pellegrini F, Craig JC, Elder GJ, et al. Serum levels of phosphorus, parathyroid hormone, and calcium and risks of death and cardiovascular disease in individuals with chronic kidney disease: a systematic review and meta analysis. JAMA 2011;305:1119-27.
  • 7. Regidor DL, Kovesdy CP, Mehrotra R, Rambod M, Jing J, McAllister CJ, et al. Serum alkaline phosphatase predicts mortality among maintenance hemodialysis patients. J Am SocNephrol 2008;19:2193-203.
  • 8. Dhingra R, Sullivan LM, Fox CS, Wang TJ, D’Agostino RB Sr, Gaziano JM, et al. Relations of serum phosphorus and calcium levels to the incidence of cardiovascular disease in the community. Arch Intern Med 2007;167:879-85.
  • 9. Tonelli M, Curhan G, Pfeffer M, Sacks F, Thadhani R, Melamed ML, et al. Relation between alkaline phosphatase, serum phosphate and all-cause or cardiovascular mortality. Circulation 2009;120:1784-92.
  • 10. Park JB, Kang DY, Yang HM, Cho HJ, Park KW, Lee HY, et al. Serum alkaline phosphatase is a predictor of mortality, myocardial infarction, or stent thrombosis after implantation of coronary drug-eluting stent. Eur Heart J 2013;34:920-31.
  • 11. Sahin I, Karabulut A, Gungor B, Avci II, Okuyan E, Kizkapan F, et al. Correlation between the serum alkaline phosphatase level and the severity of coronary artery disease. Coron Artery Dis 2014;25:349-52.
  • 12. Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol 1983;51:606.
  • 13. Ringqvist I, Fisher LD, Mock M, Davis KB, Wedel H, Chaitman BR, et al. Prognostic value of angiographic indices of coronary artery disease from the Coronary Artery Surgery Study (CASS). J Clin Invest 1983;71:1854-66.
  • 14. Scialla JJ, Wolf M. Roles of phosphate and fibroblast growth factor 23 in cardiovascular disease. Nat Rev Nephrol 2014;10:268-78.
  • 15. Gonzalez-Parra E, Rojas-Rivera J, Tuñón J, Praga M, Ortiz A, Egido J. Vitamin D receptor activation and cardiovascular disease. Nephrol Dial Transplant 2012;(27 Suppl 4):iv17-21.
  • 16. O’Neill WC. Pyrophosphate, alkaline phosphatase, and vascular calcification. Circ Res 2006;99:e2.
  • 17. Kawaguchi H, Mori T, Kawano T, Kono S, Sasaki J, Arakawa K. Band neutrophil count and the presence and severity of coronary atherosclerosis. Am Heart J 1996;132:9-12.
  • 18. Gibson PH, Cuthbertson BH, Croal BL, Rae D, El-Shafei H, Gibson G, et al. Usefulness of neutrophil/lymphocyte ratio as predictor of new-onset atrial fibrillation after coronary artery bypass grafting. Am J Cardiol 2010;105:186-91.
  • 19. Chen H, Li X, Yue R, Ren X, Zhang X, Ni A. The effects of diabetes mellitus and diabetic nephropathy on bone and mineral metabolism in T2DM patients. Diabetes Res Clin Pract 2013;100:272-6.
  • 20. Suzuki K, Ishida H, Takeshita N, Taguchi Y, Sugimoto C, Nosaka K, et al. Circulating levels of tartrate-resistant acid phosphatase in rat models of non-insulin-dependent diabetes mellitus. J Diabetes Complications 1998;12:176-80.
  • 21. Kendrick J, Targher G, Smits G, Chonchol M. 25-Hydroxyvitamin D deficiency is independently associated with cardiovascular disease in the Third National Health and Nutrition Examination Survey. Atherosclerosis 2009;205:255-60.
  • 22. Herrmann M, Sullivan DR, Veillard AS, McCorquodale T, Straub IR, Scott R, et al.; FIELD Study Investigators. Serum 25-hydroxyvitamin D: a predictor of macrovascular and microvascular complications in patients with type 2 diabetes. Diabetes Care 2015;38:521-8.
  • 23. Forouhi NG, Ye Z, Rickard AP. Circulating 25-hydroxyvitamin D concentration and the risk of type 2 diabetes in individuals with prediabetes but not with normal glucose tolerance. Diabetologia 2012;55:2173-82.
  • 24. Roe MT, Messenger JC, Weintraub WS, Cannon CP, Fonarow GC, Dai D, et al. Treatments, trends, and outcomes of acute myocardial infarction and percutaneous coronary intervention. J Am Coll Cardiol 2010;56:254-63.
  • 25. Armstrong PW, Fu Y, Chang WC, Topol EJ, Granger CB, Betriu A, et al. Acute coronary syndromes in the GUSTO-IIb trial: prognostic insights and impact of recurrent ischemia. The GUSTO-IIb Investigators. Circulation 1998;98:1860-8.
  • 26. Behar S, Haim M, Hod H, Kornowski R, Reicher-Reiss H, Zion M, et al. Long-term prognosis of patients after a Q wave compared with a non-Q wave first acute myocardial infarction. Data from the SPRINT Registry. Eur Heart J 1996;17:1532-27.
  • 27. Yan AT, Tan M, Fitchett D, Chow CM, Fowlis RA, McAvinue TG, et al; Canadian Acute Coronary Syndromes Registry Investigators. One-year outcome of patients after acute coronary syndromes (from the Canadian Acute Coronary Syndromes Registry). Am J Cardiol 2004;94:25-9.
There are 27 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Investigations
Authors

Celal Kilit

Publication Date August 1, 2017
Published in Issue Year 2017 Volume: 20 Issue: 2

Cite

Vancouver Kilit C. Value of Alkaline Phosphatase in Predicting the Extent and Severity of Coronary Artery Disease in Acute Myocardial Infarction. Koşuyolu Heart Journal. 2017;20(2):91-7.