High serum matrix metalloproteinase-9 level predict increased risk of in-hospital cardiac events in patients with type 2 diabetes and ST segment elevation myocardial infarction
Introduction
Matrix metalloproteinases (MMPs) are part of an endogenous family of enzymes responsible for extracellular collagen degradation and remodelling [1]. Among the known MMPs, MMP-2 is distributed throughout the cardiac myocytes and fibroblasts, whereas MMP-9 is mainly expressed in infiltrating inflammatory cells such as neutrophils and macrophages [2], [3]. Results of previous studies have shown that serum MMP-9 levels are higher in patients with acute myocardial infarction (AMI) [4], [5]. Similarly, values of MMP-9 have shown to provide valuable prognostic information on short- and long-term mortality in patients with AMI [6].
Patients with diabetes mellitus have an increased risk of cardiovascular morbidity and mortality [7]. After AMI, diabetic patients have a significantly higher risk of heart failure and cardiogenic shock and therefore a worse outcome, in both short- and long-term [8]. Arteriosclerotic lesions in patients with diabetes mellitus are more unstable than those of nondiabetic subjects [9]. So far, no studies have yet been conducted concerning serum MMP–9 levels after AMI and their relationship with short-term outcomes in diabetic patients. Thus, the aim of our present study was to compare serum MMP-9 levels in a population of type 2 diabetic versus non-diabetic patients hospitalized for ST segment elevation myocardial infarction (STEMI) and to examine the relationship between serum MMP-9 levels and the incidence of in-hospital cardiac events, including death and cardiogenic shock.
Section snippets
Patients
During a period of 18 months, we enrolled 120 consecutive patients with STEMI who were admitted to our institution and fulfilled all of the following criteria: (1) typical, prolonged (>30 min) chest pain at rest; (2) ST-segment elevation ≥0.2 mV at the J point in two or more contiguous precordial leads or ≥0.1 in two or more adjacent limb leads on the standard 12-lead electrocardiogram; (3) presentation in the first 6 h since the onset of chest pain. Diagnosis of AMI was confirmed by increased
Statistical analysis
Results for normality distributed continuous variables are expressed as the mean value ± standard deviation. Analysis of normality of the continuous variables was performed with the Kolmogorov–Smirnov test. Comparisons of continuous variables between type 2 diabetic and nondiabetic patients were performed either by unpaired Student's t-test. Analysis of covariance was used to compare serum MMP-9 mean values between type 2 diabetic and non-diabetic patients after adjustment for potential
Results
Baseline clinical characteristics result in the 120 patients included in the study, are shown in Table 1. They were treated in our hospital with percutaneous coronary intervention. The procedure was performed successfully with re-establishment of TIMI 3 flow in the artery responsible for the infarction. Thus, 120 patients fulfilled the inclusion criteria, of whom 48 of them (40%) were type 2 diabetic, 45 of them (37.5%) had previously known type 2 diabetes, and 3 of them (2.5%) had newly
Discussion
We have shown in the present study, from a cohort of patients hospitalized with STEMI, that type 2 diabetic patients have significantly higher serum MMP-9 levels and that elevated MMP-9 is strongly associated to the increased incidence of in-hospital mortality and cardiogenic shock.
The best of our knowledge, MMP-9 has never been studied in population of type 2 diabetic patients after STEMI. In the present study, we found a significant increase in serum MMP-9 in type 2 diabetic patients compared
Acknowledgement
The authors wish to express their gratitude to Ines Abreu-Afonso for the liguistic aids preparing the manuscript.
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