ABC | Volume 113, Nº1, July 2019

Original Article Kızıltunç et al. Sirtuins in acute myocardial infarction patients Arq Bras Cardiol. 2019; 113(1):33-39 English‑language literature. The goal of this pilot study is to investigate temporal changes of serum sirtuin 1,3 and 6 levels in AMI patients, to determine if there is any difference in serum sirtuin 1,3 and 6 levels between AMI patients and control subjects and to investigate the association between serum sirtuin 1,3 and 6 levels and prognostic markers of AMI patients like peak serum troponin levels, serum pro-BNP levels, GRACE score and post-MI LVEF. Methods The study protocol was approved by the local ethical committee and informed consent forms were obtained from all participants. We enrolled patients with acute ST‑segment elevational MI (STEMI) and patients with normal coronary arteries in this cross-sectional study between June 2017 and November 2017. Patients with STEMI were diagnosed according to the third universal definition of myocardial infarction document. 15 A primary percutaneous coronary intervention was performed and all of the STEMI patients received guideline‑mediated medical therapy. GRACE risk score 16 and TIMI risk score 17 of the AMI patients were calculated. The duration between symptom onset to reperfusion, location of the infarction in electrocardiogram and presence of pre‑infarction angina pectoris were recorded. Serum lipid levels, renal and hepatic function test results, complete blood count results, fasting blood glucose levels, and peak troponin T levels were also recorded. Serum C reactive protein levels and pro BNP levels were processed on the first day of ischemic insult in AMI patients. Venous samples were obtained at the admittance, 24th hour and 48th hour of the infarction for sirtuin 1,3 and 6 analysis to see whether there was any temporal change in serum sirtuin levels after myocardial infarction. Serum lipid levels, renal and hepatic function test results, complete blood count results and fasting blood glucose levels were obtained from local laboratory records and venous samples were collected for C reactive protein, pro BNP and sirtuin level analysis after the coronary angiography in normal coronary artery patients. Transthoracic echocardiography was performed and the LVEF, end diastolic diameter, septal and posterior wall thickness were recorded in all patients. All of the samples for sirtuin level analysis were centrifuged at 4000 rpm for 10 minutes, serums were separated and were frozen at -80 degrees Celsius. All sirtuin 1,3 and 6 levels were processed simultaneously with human sirtuin ELISA kits (YL Biotech, Shanghai, PRC). Excluded from the study were as follows: The patients with a past history of MI, stable coronary artery disease, peripheral arterial disease, heart failure and any valvular heart disease, the patients with malignancy, active infection, any chronic inflammatory disease, and any chronic renal or hepatic disease. Statistical analysis SPSS 18.0 software for Windows (SPSS Inc. Chicago, IL) was used for analysis of data. For continuous variables, the normality of distribution was tested using Kolmogorov-Smirnov test. The results were presented as themean± standard deviation for variables with normal distribution and as median (interquartile range 25-75) for variables with abnormal distribution. The statistical comparisons of continuous variables were performed using independent samples t-test orMann‑WhitneyU test regarding the distribution pattern. The comparisons of categorical variables were performed using Chi-square test or Fisher’s exact test. While investigating the association between sirtuins and prognostic markers of AMI, the correlation coefficients and their significance were calculated using the Spearman test. In AMI patients, serial serum sirtuin 1,3 and 6 levels were processed at the admittance, first day and the second day of the infarction and the Friedman test was conducted to test whether there was a significant temporal change in serum sirtuin levels in AMI patients. A p value < 0.05 was considered statistically significant. Results Forty consecutive STEMI patients and 40 consecutive control patients with normal coronary arteries were included into the study. Baseline clinical and laboratory characteristics of the patients were shown in table 1. White blood cell count, neutrophil count, serum creatinine, CRP, proBNP values and left ventricle mass index were significantly higher in the AMI group than in the control group. The control group was composed of more female patients and less smoking patients. The mean platelet count and the mean left ventricular ejection fraction were significantly higher in the control group than in the AMI group. There was no significant temporal change in serum sirtuin levels in AMI patients (Figure 1). Clinical and laboratory features of AMI patients were shown in table 2. Fifteen patients experienced pre-infarction angina pectoris before the ischemic insult. Median peak troponin level was 41.6 ng/L in patients without pre-infarction angina and 28.2 ng/L in patients with pre-infarction angina (p = 0.202). Baseline serum sirtuin 1, 3 and 6 levels were similar in the patients with and without pre-infarction angina. No correlation was evident between baseline serum sirtuin levels and following parameters: CRP levels, peak troponin T levels, proBNP levels and LVEF. Baseline sirtuin 1 and 6 levels were positively correlated with reperfusion duration. On the other hand, baseline sirtuin 3 levels were significantly negatively correlated with GRACE score (Table 3). Discussion In this pilot study, we investigated serum sirtuin 1, 3 and 6 levels in AMI patients and patients with normal coronary arteries. We found that median serum sirtuin levels were similar in AMI patients and control patients. We observed that serum sirtuin levels did not show a significant temporal change in AMI course. There was no correlation between serum sirtuin levels and prognostic markers of AMI patients like peak troponin, proBNP, CRP and ejection fraction. Serum sirtuin 1 and 6 levels were positively correlated with reperfusion duration. In addition, we found a significant negative correlation between serum sirtuin 3 levels and GRACE score. Atherosclerotic cardiovascular disease is the leading cause of death all over the world. 18 Primary and secondary prevention attempts are evolving to decrease the global burden of this devastating disorder. 19 Atherosclerosis pathogenesis is complicated and researches on the molecular basis of 34