ABC | Volume 113, Nº4, October 2019

Original Article Evaluation of Serum Levels of Inflammation, Fibrinolysis and Oxidative Stress Markers in Coronary Artery Disease Prediction: A Cross-Sectional Study Sakhavat Abolhasani, 1,2 Shahnam Valizadeh Shahbazloo, 2 Hossein Mozafar Saadati, 3 Neda Mahmoodi, 2 Nafiseh Khanbabaei 1 Department of Clinical Biochemistry - Student Research Committee - School of Medicine - Shahid Beheshti University of Medical Sciences, 1 Tehran, Iran Department of Clinical Biochemistry - Faculty of Medicine - Tabriz University of Medical Sciences, 2 Tabriz, Iran Department of Epidemiology - School of Public Health and safety - Shahid Beheshti University of Medical Sciences, 3 Tehran, Iran Mailing Address: Sakhavat Abolhasani • Department of Clinical Biochemistry, School of Medicine - Shahid Beheshti University of Medical Sciences, Yemen Street, Chamran Highway, Tehran – Iran E-mail: bio.sakhi@gmail.com Manuscript received October 26, 2018, revised manuscript December 26, 2018, accepted January 30, 2019 DOI: 10.5935/abc.20190159 Abstract Background: Coronary Artery Disease (CAD) has long been recognized as a global health issue. Inflammation, Fibrinolysis and Oxidative Stress play an important role in the disruption of plaques leading to CAD. Markers that reflect this pathophysiologic mechanism may have prognostic value. Objective: To estimate the serum concentrations of high-sensitivity C‑reactive protein (hs‑CRP), sialic acid (SA), vitronectin (VN), plasminogen activator inhibitor-1 (PAI-1), oxidized low density lipoprotein (OX-LDL) and malondialdehyde (MDA) with significant prognostic value in patients with CAD. Methods: The markers included, hs‑CRP, SA, VN, PAI-1, OX-LDL and MDA, were compared between 160 angiographically diagnosed CAD patients and 20 age- and sex-matched healthy individuals. The subjects were divided into 4 groups according to angiography results, and association between all risk factors of CAD was studied. Serum levels of SA, VN, PAI-1, and OX-LDL were measured by enzyme-linked immunosorbent assay (ELISA); MDA was measured based on reaction with thiobarbituric acid (TBA); and hs-CRP level was estimated by immunoturbidimetry using a commercial kit. The diagnostic value of these variables was further assessed by ROC curve analysis. Multiple logistic regression was used to evaluate the diagnostic power of the combination. Furthermore, p < 0.05 was considered as significant. Results: Serum levels of hs‑CRP, SA, VN, PAI-1, and OX-LDL were significantly higher in patient groups compared to control group (p < 0.001). Using both normal and CAD patients as subjects, ROC analysis was performed. The cutoff for OX-LDL, MDA, PAI-1, VN, hs‑CRP and SA was 2.67 (ug/mL), 5.49 (mmol/mL), 67 (ng/mL), 254 (ng/mL), 3.4 (mg/dL), 7/89 (mg/dL), respectively. Eventually, the complete diagnostic efficacy was classified as: SA, hs‑CRP, PAI-1, OX-LDL, MDA and VN. Conclusion: Serum levels SA, hs‑CRP, VN, PAI-1, OX-LDL and MDA may be predictive of adverse cardiovascular outcomes. Interestingly, these analyses can help as diagnostic and monitoring markers in CAD patients. (Arq Bras Cardiol. 2019; 113(4):667-674) Keywords: Coronary Artery Disease; Biomarkers; Inflammation Fibrinolysis; Oxidative Stress; Sialic Acids; Vitronectin. Introduction Atherosclerotic coronary artery disease (CAD) remains one of the world’s major health problems, accounting for 12.7% of global mortality. 1 As we know, atherosclerosis is known as a chronic inflammatory process that is initiated with the dysfunction or activation of the arterial endothelium. Moreover, endothelial damage and reactive oxygen species (and other free radicals) have emerged as main factors in practically all pathways that lead to the development of atherosclerosis. 2 Risk factors identified recently that are related to pro-atherogenic cardiovascular disease include those associated with impaired coagulation or fibrinolysis, cardiovascular remodeling and inflammation. 3 Notably, increase in plasma levels of risk markers for atherosclerotic cardiovascular disease have been recognized to play an important role in both the onset and the progression of atherosclerotic plaque. These prognostic markers may assist in therapy to match the intensity of the patient’s disease. 4-8 Remarkably, Vitronectin (VN) is present in plasma, extracellular matrix, and granules of blood platelets. It consists of adhesive glycoproteins, which play a key role in the regulation of processes such as platelet adhesion, aggregation and clotting, via binding to integrin, plasminogen activator inhibitor (PAI-1), urokinase plasminogen activator receptor (UPAR), and heparin. 9,10 In spite of that fact, plasma VN levels were significantly increased in patients with CAD, also showing a positive correlation with severity of the disease. 11 Notably, PAI-1 has been recognized as 667