The American journal of cardiology
-
The Thrombolysis in Myocardial Infarction (TIMI) score, derived from unstable angina/non-ST-segment elevation acute myocardial infarction patient population, predicts 14-day cardiovascular events. It has been validated in emergency department (ED) patients with potential acute coronary syndrome with respect to 30-day outcomes. Our objective was to determine whether the initial TIMI score could risk stratify ED patients with potential acute coronary syndrome with respect to the 1-year outcomes. ⋯ Of 2,819 patients, 253 (9%) met the composite outcome. The overall incidence of the composite 1-year outcome of death (n = 119), acute myocardial infarction (n = 96), and revascularization (n = 90) according to TIMI score was TIMI 0 (n = 1,162), 4%; TIMI 1 (n = 901), 8%; TIMI 2 (n = 495), 13%; TIMI 3 (n = 193), 23%; TIMI 4 (n = 60), 28%; and TIMI 5 to 7 (n = 8), 88% (p <0.001). In conclusion, in addition to risk stratifying ED patients with chest pain at the initial ED evaluation, the TIMI score can also predict the 1-year cardiovascular events in this patient population.
-
Atherosclerosis is an inflammatory disease in which systemic inflammation correlates with disease activity. Matrix metalloproteinases (MMPs) contribute to collagen breakdown in atherosclerotic plaques. In the present study, we investigated whether the ratio of MMP-9 and its endogenous inhibitor, tissue inhibitor of metalloproteinase (TIMP)-1, in circulating monocytes correlates with the clinical stages of coronary artery disease. ⋯ The activity of serum MMP-9 correlated with the individual MMP-9/TIMP-1 ratio in the peripheral circulating monocytes (r(2) = 0.82, p <0.02). In conclusion, the progression of coronary artery disease was mirrored by an increasing MMP-9/TIMP-1 ratio in the peripheral circulating CD14+ monocytes and serum, respectively. Circulating monocytes displayed the same pattern of imbalance in the expression of MMP-9 and TIMP-1 as previously reported for monocyte-derived macrophages within atherosclerotic plaques, supporting the notion of atherosclerosis as a systemic inflammatory disease.