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Vitronectin (VN), a 459 aminoacid long glycoprotein with a mass of 75 kDa, is found in plasma, extracellular matrix (ECM) and α granules of platelets. VN functions as a regulator of platelet adhesion and aggregation, coagulation and fibrinolysis. Plasma VN levels were found to be elevated in patients with coronary artery disease (CAD), and a positive correlation between VN levels and CAD severity has been demonstrated. VN was also shown to be an independent predictor of adverse cardiovascular outcomes following acute stenting in patients with acute coronary syndromes (ACS) or stable angina.
The aim of this study was to investigate the diagnostic role of serum VN level at admission in patients with ACS. The relation between extent of CAD and VN levels was also investigated.
Sixty-two patients (40 men, mean age 59.9±10.3 years and 22 women, mean age 68.9±11.2 years), who had been admitted to coronary care unit with first time diagnosis of ACS (ST elevation myocardial infarction [STEMI], non-ST elevation myocardial infarction [NSTEMI]) were consecutively included in the study.The control group consisted of 18 stable patients in whom normal coronary arteries were documented in coronary angiography. Patients were divided into two sub-groups as STEMI and NSTEMI. Blood samples were drawn within 6 hours after onset of chest pain and serum VN, high sensitive C-reactive protein (hs-CRP) and N-terminal probrain natriuretic peptide (NT-proBNP) levels were measured using an enzyme immunoassay method. Also, TIMI and GRACE clinical risk scores were calculated on admission for all ACS patients. Appropriate statistical methods were utilized to evaluate the diagnostic value of VN in ACS.
The VN serum levels were demonstrated to be higher in MI patients (7.00±11.94 μg/ml in STEMI group, 7.72±18.02 μg/ml in NSTEMI group vs. 1.81±2.22 μg/ml in controls, p=0.012). When VN levels were compared between STEMI and NSTEMI groups, no significant differences were observed (p=0.41). Also, there was a significant positive correlation between VN levels and Gensini score only in NSTEMI patients (r=0.436, p=0.013). When the diagnostic value of VN levels for MI was investigated, a cut-off value of 1.59 μg/ml yielded a sensitivity of 64%, a specificity of 84%, a positive predictive value of 93%, and a negative predictive value of 41%. Also, when the diagnostic utility of VN was assessed using ROC analysis, an area under the curve (AUC) of 0.72 was found (95% CI: 0.60-0.84; p=0.004; Figure).
The present study demonstrate that, VN may have a utility as a diagnostic marker in patients with ACS. Also, VN may have a role to predict extension and severity of CAD in patients with NSTEMI.