ABC | Volume 113, Nº4, October 2019

Original Article Abolhasani et al. Serum levels of markers in CAD prediction Arq Bras Cardiol. 2019; 113(4):667-674 Figure 1 – ROC analysis of VN, MDA, OX-LDL, PAI-1, hs‑CRP and SA. VN: vitronectin; MDA: malondialdehyde; OX-LDL: oxidized low density lipoprotein; PAI-1: plasminogen activator inhibitor-1; hs‑CRP: high-sensitivity C‑reactive protein; SA: sialic acid. ROC Curve Sensitivity 1.0 0.8 0.6 0.4 0.2 0.0 1 – Specificity 0.0 0.2 0.4 0.6 0.8 1.0 Source of the Curve hscrp SialicAcid OXLDL MDA PAI1 VT Reference Line Several studies have found a regulatory function for VN in the hemostatic response to vascular injury. 9 Also, VNbinds PAI-1 and adjusts its action by stabilizing the active PAI-1 conformation, and potentially controls PAI-1 clearance. 27 Serum levels of VN were found to be increased patients with CADwhen compared with controls. 9,11 Derer et al. 26 suggested that VN is a clinically useful biomarker for unfavorable cardiovascular outcomes in patients following acute stenting undergoing coronary interventions. 26 Therefore, VN may serve as a marker for CAD, and elevated levels may indicate its role in the diagnosis and/or progression of CAD. Notably, there is suggestion that high plasma PAI-1 concentrations are related with the progression of coronary syndromes and the development of myocardial infarction. 26,28 Clinical and experimental studies demonstrated that PAI-1 deficiency in humans is accompanied by abnormal bleeding, whereas elevated PAI-1 plasma levels are associated with vascular thrombosis, indicating the crucial role of PAI-1 in hemostatic clot stabilization. 13 Moreover, previous studies have shown that PAI-1 is significantly elevated in CAD patients in comparison to controls, and it has also a significant relationship with severity of the disease. 20,29 In addition, it was reported that PAI-1 is an independent predictor of coronary microvascular dysfunction in hypertension. 30 Our results suggested that prominent levels of PAI-1 concentrations may predict and be a diagnosis marker for CAD. Furthermore, oxidative stress has an important role in the beginning and progression of atherosclerosis. OX-LDL is more atherogenic than the native LDL, and has been recognized to accumulate in atherosclerotic lesions in the aorta and coronary arteries of patients with CAD. 2,8,17 Additionally, MDA is produced from breakdown of lipids during peroxidation processes, and serum MDA is a reliable marker of oxidative damages. Previous findings also have confirmed the involvement of lipid peroxidation in CAD by referring to the plasma levels of MDA observed in CAD patients compared with healthy controls. More recent cross‑sectional studies demonstrated a positive relationship between elevated levels of OX-LDL and MDA with severity of acute coronary syndromes. 20,31 Ehara et al. 32 reported that the plasma OX‑LDL level in patients with CAD increases by approximately 3.5 fold than in control subjects. 32 Remarkably, the findings in this study indicated that both oxidative stress parameters can be used as diagnosis markers of CAD, and the impact of this oxidative stress may progress to an atherosclerotic event. Impressively, in arterial injury accompanied by inflammatory response, inflammation plays a key role in the pathogenesis of CAD and its impediments. Hence, SA and hs-CRP have gained importance as inflammatory markers and as indicators and predictors of the process of acute coronary syndromes. 19,33 Increased production 670