Association between Plasma Thiol Parameters and Troponin Levels in Patients with Acute Coronary Syndrome and Prediction of In-Hospital Ventricular Arrhythmia

Erdoğan, Mehmet; Ozturk, Selcuk; Tutar, Elçin Özdemir; Arslan, Esma; Çelik, Muhammet Cihat; Baştuğ, Serdal; Neşelioğlu, Salim

doi:10.36660/abc.20190672

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Original Article • Arq. Bras. Cardiol. 117 (3) • Sept 2021 • https://doi.org/10.36660/abc.20190672 copy

Association between Plasma Thiol Parameters and Troponin Levels in Patients with Acute Coronary Syndrome and Prediction of In-Hospital Ventricular Arrhythmia

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

Ventricular arrhythmias (VAs) are the main cause of in-hospital mortality and morbidity in acute coronary syndrome (ACS) patients and its relationship with thiol is not known.

Objective

To investigate the relationship between plasma thiol levels and troponin levels in patients with ACS and to estimate in-hospital VA development during hospital stay.

Method

The study included 231 consecutive ST-segment elevation ACS (STE-ACS) and non-ST-segment elevation ACS (NSTE-ACS) patients. After application of exclusion criteria, 191 patients were included in the statistical analysis. Patients were classified into two groups: STE-ACS group (n=94) and NSTE-ACS group (n=97). Plasma thiol, disulphide and troponin levels were measured and troponin-to-native thiol ratio (TNTR) was calculated. A two-sided p value of less than 0.05 was considered to be statistically significant.

Results

Plasma native thiol, total thiol, disulphide and their ratios were similar between the groups. TNTR was significantly higher in the STE-ACS group compared to the NSTE-ACS group. Troponin and thiol levels correlated negatively and significantly. Native thiol was found to be an independent predictor of VA development in STE-ACS patients and in all ACS patients. TNTR was found to be an independent predictor of VA development in NSTE-ACS patients and in all ACS patients.

Conclusion

Plasma thiol levels can be used to identify ACS patients at high risk for in-hospital VA development. Correlation between troponin and thiol levels may suggest that thiols may be an important marker for diagnosis and prognosis of ACS with the help of future studies.

Atherosclerosis; Coronary Artery Disease; Coronary Acute, Syndrome; Oxidative Stress; Arrhythmias, Cardiacs; Acetyl- CoA-Acyltransferase

Variables	STE-ACS (n=94)	NSTE-ACS (n=97)	p value
Age, years	58.7±11.1	62.1±13.7	0.06
Gender (male), n (%)	80 (85)	71 (73)	0.05
BMI (kg/m²)	26.9±6.9	28.5±5.6	0.14
Hypertension, n (%)	39 (41)	61 (62)	0.003*
Diabetes mellitus, n (%)	22 (23)	43 (44)	0.02*
Smoking, n (%)	65 (69)	44 (45)	0.001*
Atrial fibrillation, n (%)	0 (0)	8 (8)	0.07
Admission time, hours	2 (1–5)	28 (7–72)	<0.001*
Neutrophil count (K/uL)	7650 (5500–11525)	6100 (4600–8150)	<0.001*
Lymphocyte count (K/uL)	1900 (1222–3025)	1900 (1525–2500)	0.81
NLR	5.0 (2.0–7.9)	2.7 (2.1–4.5)	0.02*
Platelet count (K/uL)	252±79	231±63	0.04*
Hemoglobin (g/dl)	14.4±1.7	13.7±1.8	0.08
Albumin (g/dl)	4.1±0.4	4.2±0.3	0.21
Total cholesterol (mg/dl)	182±42	194±53	0.07
HDL (mg/dl)	37 (31–45)	39 (33–47)	0.06
LDL (mg/dl)	119±33.5	116±36.5	0.57
Triglycerides (mg/dl)	97.5 (60–154)	130 (91–189)	<0.001*
Potassium (mmol/L)	4.3±0.4	4.4±0.5	0.14
Creatinine (mg/dl)	0.9 (0.7–1.0)	0.9 (0.7–1.1)	0.31
GFR (mL/min/m²)	90 (72–144)	86 (60–96)	0.07
Calcium (mg/dl)	9.2±0.6	9.3±0.5	0.17
Magnesium (mg/dl)	2.0 (1.9–2.2)	2.0 (1.9–2.2)	0.79
AST (U/L)	30.5 (20–52)	30 (21–39)	0.34
ALT (U/L)	24 (16–34)	21 (14–30)	0.13
CK–MB Mass (ng/mL)	100 (26–209)	13 (3–66)	<0.001*
Troponin I (μg/L)	2571 (736–4810)	365 (43–1394)	<0.001*
LVEF (%)	43.9±8.5	49±11.2	<0.001*
Troponin/native thiol	6.7 (1.9 -15.8)	1.0 (0.1 - 3.8)	<0.001*
Plasma native thiol (µmol/l)	359.8±78.4	366.6±68.5	0.52
Plasma total thiol (µmol/l)	401.3±81.7	407.6±74.4	0.57
Disulphide (µmol/l)	20.1±10.8	19.0±11.9	0.53
Disulphide/native thiol	0.04 (0.03–0.08)	0.05 (0.03–0.07)	0.49
Disulphide/total thiol	0.04 (0.03–0.07)	0.04 (0.02–0.06)	0.53
Native thiol/total thiol	0.90 (0.86–0.94)	0.91 (0.87–0.95)	0.16
TIMI risk score	2 (1–4)	4 (3–5)	-
GRACE score	151.7±26.6	133.7±35.1	<0.001*
Ventricular arrhythmia, n (%)	13 (13.8)	10 (10.3)	0.45
Length of hospital stay, days	4 (3–5)	4 (3–5)	0.26
Mortality, n (%)	3 (3)	1 (1)	0.36

Variables	Native Thiol		Total Thiol		Troponin-to-Native Thiol Ratio

	r	p	r	p	r	p
Age	-0.25	<0.001*	-0.26	<0.001*	+0.06	0.34
GFR	+0.33	<0.001*	+0.33	<0.001*	-0.13	0.06
Grace score	-0.36	<0.001*	-0.35	<0.001*	+0.40	<0.001*
LVEF (%)	+0.19	0.009*	+0.18	0.01*	-0.42	<0.001*
NLR	-0.14	0.04*	-0.14	0.054	+0.34	<0.001*
Albumin	+0.39	<0.001*	+0.41	<0.001*	-0.12	0.07
Troponin	-0.27	<0.001*	-0.28	<0.001*	-	-
CK-MB Mass	-0.11	0.12	-0.10	0.15	+0.63	<0.001*
Hospital stay	-0.22	0.002*	-0.16	0.02*	+0.23	0.001*
LDL	+0.10	0.14	+0.13	0.06	+0.04	0.57

Variables	OR	95%CI		p value

		Lower	Upper
Ventricular arrhythmia/STE
LDL	1.021	0.997	1.045	0.08
Age	1.026	0.965	1.091	0.40
LVEF (%)	1.044	0.943	1.155	0.40
Potassium	0.849	0.214	3.366	0.81
Magnesium	1.072	0.121	9.518	0.95
NLR	1.142	0.997	1.308	0.05
Admission time	1.016	0.994	1.038	0.15
Troponin/native thiol	1.030	0.981	1.081	0.23
Troponin	1.000	1.000	1.000	0.64
Native thiol	0.962	0.937	0.986	0.03*
Nagelkerke R ² = 0.257, p: 0.07
Ventricular arrhythmia/NSTE-ACS
LDL	0.970	0.940	1.001	0.05
Age	1.086	0.985	1.196	0.09
LVEF (%)	1.034	0.917	1.165	0.58
Potassium	1.278	0.218	7.488	0.78
Magnesium	0.105	0.001	11.00	0.34
NLR	1.102	0.919	1.321	0.29
Admission time	1.003	0.988	1.019	0.68
Troponin/native thiol	1.263	1.061	1.504	0.009*
Troponin	1.001	1.000	1.001	0.05
Native thiol	0.969	0.947	0.992	0.08
Nagelkerke R ² = 0.592, p<0.001
Ventricular arrhythmia/All patients
LDL	1.001	0.987	1.015	0.90
Age	1.040	0.998	1.084	0.06
LVEF (%)	0.994	0.940	1.051	0.82
Potassium	0.867	0.346	2.169	0.76
Magnesium	0.681	0.096	4.845	0.70
NLR	1.087	1.000	1.182	0.05
Admission time	1.002	0.995	1.008	0.57
Troponin/native thiol	1.059	1.022	1.098	0.002*
Troponin	1.000	1.000	1.000	0.10
Native thiol	0.976	0.966	0.986	<0.001*
Nagelkerke R2 =0.240, p: 0.001

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