The current status and outcomes of in-hospital P2Y12 receptor inhibitor switching in Korean patients with acute myocardial infarction

Background/Aims@#While switching strategies of P2Y12 receptor inhibitors (RIs) have sometimes been used in acute myocardial infarction (AMI) patients, the current status of in-hospital P2Y12RI switching remains unknown. @*Methods@#Overall, 8,476 AMI patients who underwent successful revascularization from Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH) were divided according to in-hospital P2Y12RI strategies, and net adverse cardiovascular events (NACEs), defined as a composite of cardiac death, non-fatal myocardial infarction (MI), stroke, or thrombolysis in myocardial infarction (TIMI) major bleeding during hospitalization were compared. @*Results@#Patients with in-hospital P2Y12RI switching accounted for 16.5%, of which 867 patients were switched from clopidogrel to potent P2Y12RI (C-P) and 532 patients from potent P2Y12RI to clopidogrel (P-C). There were no differences in NACEs among the unchanged clopidogrel, the unchanged potent P2Y12RIs, and the P2Y12RI switching groups. However, compared to the unchanged clopidogrel group, the C-P group had a higher incidence of non-fatal MI, and the P-C group had a higher incidence of TIMI major bleeding. In clinical events of in-hospital P2Y12RI switching, 90.9% of non-fatal MI occurred during pre-switching clopidogrel administration, 60.7% of TIMI major bleeding was related to pre-switching P2Y12RIs, and 71.4% of TIMI major bleeding was related to potent P2Y12RIs. Only 21.6% of the P2Y12RI switching group switched to P2Y12RIs after a loading dose (LD); however, there were no differences in clinical events between patients with and without LD. @*Conclusions@#In-hospital P2Y12RI switching occurred occasionally, but had relatively similar clinical outcomes compared to unchanged P2Y12RIs in Korean AMI patients. Non-fatal MI and bleeding appeared to be mainly related to pre-switching P2Y12RIs.

Exercise-induced polymorphic ventricular tachycardia by the R-on-T phenomenon in a patient with stable angina pectoris

Polymorphic ventricular tachycardia (PVT) is a fatal arrhythmia that can occur during the treadmill test. This report documents an instance of PVT by the R-on-T phenomenon during an exercise stress test in a 61-year-old male with stable angina pectoris. The subject performed the treadmill test for 581 seconds, and stopped after reaching 115% of the target heart rate. Ischemic ST changes were observed in leads II, III, aVF, and V3-V6 from stage 3. Premature ventricular complexes were noted during the recovery period, with an occurrence of pulseless PVT, reflective of the R-on-T phenomenon. Spontaneous circulation was resumed after unsynchronized cardioversion at 200 J and 2 minutes of cardiopulmonary resuscitation. Emergency coronary angiography revealed 95% stenosis of the proximal right coronary artery, which was fully dilated after percutaneous coronary intervention with a drug-eluting stent. The patient was discharged without any neurologic sequelae.

Clopidogrel versus Aspirin after Dual Antiplatelet Therapy in Acute Myocardial Infarction Patients Undergoing Drug-Eluting Stenting

BACKGROUND AND OBJECTIVES@#There is a paucity of data regarding the benefit of clopidogrel monotherapy after dual antiplatelet therapy (DAPT) in patients treated with drug-eluting stents (DES). This study compared outcome between clopidogrel versus aspirin as monotherapy after DES for acute myocardial infarction (MI).@*METHODS@#From Korea Acute Myocardial Infarction Registry-National Institute of Health database, 1,819 patients treated with DES who were switched to monotherapy with clopidogrel (n=534) or aspirin (n=1,285) after uneventful 12-month DAPT were analyzed. The primary endpoint was net adverse clinical events (NACE), defined as a composite of death from any cause, MI, repeat percutaneous coronary intervention (PCI), stent thrombosis, ischemic stroke, or major bleeding during the period from 12 to 24 months.@*RESULTS@#After adjustment using inverse probability of treatment weighting, patients who received clopidogrel, compared with those treated with aspirin, had a similar incidence of NACE (0.7% and 0.7%; hazard ratio, 1.06; 95% confidence interval, 0.31–3.60; p=0.923). The 2 groups had similar rates of death from any cause (0.1% in each group, p=0.789), MI (0.3% and 0.1%, respectively; p=0.226), repeat PCI (0.1% and 0.3%, respectively; p=0.548), stent thrombosis (0.1% and 0%, respectively; p=0.121), major bleeding (0.2% in each group, p=0.974), and major adverse cardiovascular and cerebrovascular events (0.5% in each group, p=0.924).@*CONCLUSIONS@#Monotherapy with clopidogrel, compared to aspirin, after DAPT showed similar clinical outcomes in patients with acute MI treated with DES.

Pre-hospital delay and emergency medical services in acute myocardial infarction

Background/Aims@#Minimising total ischemic time (TIT) is important for improving clinical outcomes in patients with ST-segment elevation myocardial infarction who have undergone percutaneous coronary intervention (PCI). TIT has not shown a significant improvement due to persistent pre-hospital delay. This study aimed to investigate the risk factors associated with pre-hospital delay. @*Methods@#Individuals enrolled in the Korea Acute Myocardial Infarction Registry-National Institutes of Health between 2011 and 2015 were included in this study. The study population was analyzed according to the symptom-to-door time (STDT; within 60 or > 60 minutes), and according to the type of hospital visit (emergency medical services [EMS], non-PCI center, or PCI center). @*Results@#A total of 4,874 patients were included in the analysis, of whom 28.4% arrived at the hospital within 60 minutes of symptom-onset. Old age (> 65 years), female gender, and renewed ischemia were independent predictors of delayed STDT. Utilising EMS was the only factor shown to reduce STDT within 60 minutes, even when cardiogenic shock was evident. The overall frequency of EMS utilisation was low (21.7%). Female gender was associated with not utilising EMS, whereas cardiogenic shock, previous myocardial infarction, familial history of ischemic heart disease, and off-hour visits were associated with utilising EMS. @*Conclusions@#Factors associated with delayed STDT and not utilising EMS could be targets for preventive intervention to improve STDT and TIT.

Clopidogrel versus Aspirin after Dual Antiplatelet Therapy in Acute Myocardial Infarction Patients Undergoing Drug-Eluting Stenting

BACKGROUND AND OBJECTIVES: There is a paucity of data regarding the benefit of clopidogrel monotherapy after dual antiplatelet therapy (DAPT) in patients treated with drug-eluting stents (DES). This study compared outcome between clopidogrel versus aspirin as monotherapy after DES for acute myocardial infarction (MI).METHODS: From Korea Acute Myocardial Infarction Registry-National Institute of Health database, 1,819 patients treated with DES who were switched to monotherapy with clopidogrel (n=534) or aspirin (n=1,285) after uneventful 12-month DAPT were analyzed. The primary endpoint was net adverse clinical events (NACE), defined as a composite of death from any cause, MI, repeat percutaneous coronary intervention (PCI), stent thrombosis, ischemic stroke, or major bleeding during the period from 12 to 24 months.RESULTS: After adjustment using inverse probability of treatment weighting, patients who received clopidogrel, compared with those treated with aspirin, had a similar incidence of NACE (0.7% and 0.7%; hazard ratio, 1.06; 95% confidence interval, 0.31–3.60; p=0.923). The 2 groups had similar rates of death from any cause (0.1% in each group, p=0.789), MI (0.3% and 0.1%, respectively; p=0.226), repeat PCI (0.1% and 0.3%, respectively; p=0.548), stent thrombosis (0.1% and 0%, respectively; p=0.121), major bleeding (0.2% in each group, p=0.974), and major adverse cardiovascular and cerebrovascular events (0.5% in each group, p=0.924).CONCLUSIONS: Monotherapy with clopidogrel, compared to aspirin, after DAPT showed similar clinical outcomes in patients with acute MI treated with DES.

Intensity of Statin Treatment in Korean Patients with Acute Myocardial Infarction and Very Low LDL Cholesterol

OBJECTIVE: Data on the intensity of statin therapy for patients with acute myocardial infarction (MI) and very low baseline low-density lipoprotein (LDL) cholesterol level are lacking. We sought to assess the impact of statin intensity in patients with acute MI and LDL cholesterol <70 mg/dL. METHODS: A total of 1,086 patients with acute MI and baseline LDL cholesterol <70 mg/dL from the Korea Acute Myocardial Infarction Registry-National Institute of Health database were divided into less intensive statin (expected LDL reduction <40%, n=302) and more intensive statin (expected LDL reduction ≥40%, n=784) groups. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCEs), a composite of cardiac death, MI, revascularization occurring at least 30 days after admission, and stroke, at 12 months. RESULTS: After 1:2 propensity matching, differences were not observed between less intensive (n=302) and more intensive statin (n=604) groups in incidence of cardiac death (0.3% vs. 0.3%) and hemorrhagic stroke (0.3% vs. 0.5%, p=0.727) at 12 months. Compared with the less intensive statin group, the more intensive statin group showed lower target-vessel revascularization (4.6% vs. 1.8%, p=0.027) and MACCE (11.6% vs. 7.0%, p=0.021). Major bleeding was not different between less intensive and more intensive statin groups (1.0% vs. 2.6%, p=0.118). CONCLUSION: More intensive statin therapy was associated with significantly lower major adverse cardiovascular events in patients with acute MI and very low LDL cholesterol compared with less intensive statin therapy.

Painful erythematous nodules in the left finger pads

No abstract available.

Current Awareness and Use of the Strain Echocardiography in Routine Clinical Practices: Result of a Nationwide Survey in Korea

BACKGROUND: Because conventional echocardiographic parameters have several limitations, strain echocardiography has often been introduced in clinical practice. However, there are also obstacles in using it in clinical practice. Therefore, we wanted to find the current status of awareness on using strain echocardiography in Korea. METHODS: We conducted a nationwide survey to evaluate current use and awareness of strain echocardiography from the members of the Korean Society of Echocardiography. RESULTS: We gathered total 321 questionnaires from 25 cardiology centers in Korea. All participants were able to perform or interpret echocardiographic examinations. All participating institutions performed strain echocardiography. Most of our study participants (97%) were aware of speckle tracking echocardiography and 185 (58%) performed it for clinical and research purposes. Two-dimensional strain echocardiography was the most commonly used modality and left ventricle (LV) was the most commonly used cardiac chamber (99%) for clinical purposes. Most of the participants (89%) did not think LV strain can replace LV ejection fraction (LVEF) in their clinical practice. The common reasons for not performing routine use of strain echocardiography was diversity of strain measurements and lack of normal reference value. Many participants had a favorable view of the future of strain echocardiography. CONCLUSION: Most of our study participants were aware of strain echocardiography, and all institutions performed strain echocardiography for clinical and research purposes. However, they did not think the LV strain values could replace LVEF. The diversity of strain measurements and lack of normal reference values were common reasons for not using strain echocardiography in clinical practice.

Psychiatric Characteristics of the Cardiac Outpatients with Chest Pain

BACKGROUND AND OBJECTIVES: A cardiologist's evaluation of psychiatric symptoms in patients with chest pain is rare. This study aimed to determine the psychiatric characteristics of patients with and without coronary artery disease (CAD) and explore their relationship with the intensity of chest pain. SUBJECTS AND METHODS: Out of 139 consecutive patients referred to the cardiology outpatient department, 31 with atypical chest pain (heartburn, acid regurgitation, dyspnea, and palpitation) were excluded and 108 were enrolled for the present study. The enrolled patients underwent complete numerical rating scale of chest pain and the symptom checklist for minor psychiatric disorders at the time of first outpatient visit. The non-CAD group consisted of patients with a normal stress test, coronary computed tomography angiogram, or coronary angiogram, and the CAD group included those with an abnormal coronary angiogram. RESULTS: Nineteen patients (17.6%) were diagnosed with CAD. No differences in the psychiatric characteristics were observed between the groups. "Feeling tense", "self-reproach", and "trouble falling asleep" were more frequently observed in the non-CAD (p=0.007; p=0.046; p=0.044) group. In a multiple linear regression analysis with a stepwise selection, somatization without chest pain in the non-CAD group and hypochondriasis in the CAD group were linearly associated with the intensity of chest pain (β=0.108, R2=0.092, p=0.004; β= -0.525, R2=0.290, p=0.010). CONCLUSION: No differences in psychiatric characteristics were observed between the groups. The intensity of chest pain was linearly associated with somatization without chest pain in the non-CAD group and inversely linearly associated with hypochondriasis in the CAD group.

Erratum: Psychiatric Characteristics of the Cardiac Outpatients with Chest Pain

The first author's name was misspelled.

An Assay of Measuring Platelet Reactivity Using Monoclonal Antibody against Activated Platelet Glycoprotein IIb/IIIa in Patients Taking Clopidogrel

BACKGROUND AND OBJECTIVES: Residual platelet reactivity in patients who are taking clopidogrel is commonly measured with VerifyNow assay, which is based on the principle of light transmission aggregometry. However, to evaluate the residual platelet reactivity, it would be more accurate if the reactivity of platelet glycoprotein (GP) IIb/IIIa is directly monitored. In this study, PAC1, a monoclonal antibody against activated platelet GP IIb/IIIa, was used to measure the residual platelet reactivity. SUBJECTS AND METHODS: Twenty seven patients with coronary artery disease taking clopidogrel were enrolled. Platelets in whole blood were stained with fluorescein isothiocyanate (FITC)-conjugated PAC1. Mean fluorescence intensity (MFI) and % positive platelets (PP) were measured with flow cytometry, and the binding index (BI; MFI x %PP/100) was calculated. P2Y12 reaction unit (PRU) and % inhibition of VerifyNow assay were also measured in the usual manner. RESULTS: PRU of VerifyNow assay correlated significantly with MFI, %PP, and BI at 10 microM (r=0.59, 0.73, and 0.60, respectively, all p<0.005) and 20 microM of adenosine diphosphate (ADP; r=0.61, 0.75, and 0.63, respectively, all p<0.005). The % inhibition also correlated significantly with MFI, %PP, and BI at 10 microM (r=-0.60, -0.69, and -0.59, respectively, all p<0.005) and 20 microM of ADP (r=-0.63, -0.71, and -0.62, respectively, all p<0.005). CONCLUSION: Direct measurements of the reactivity of platelet GP IIb/IIIa were feasible using PAC1 and flow cytometry in patients taking clopidogrel. Further clinical studies are required to determine the cut-off values which would define high residual platelet reactivity in patients on this treatment protocol.

Bortezomib Reduces Neointimal Hyperplasia in a Rat Carotid Artery Injury Model

BACKGROUND AND OBJECTIVES: The ubiquitin-proteasome system is the major intracellular protein degradation pathway in the eukaryotic cells. Bortezomib inhibits 26S proteasome-induced I-kappaBalpha degradation and suppresses nuclear factor-kappa B (NF-kappaB) activation. We examined the effect of bortezomib on neointima formation after of a rat carotid artery balloon injury. MATERIALS AND METHODS: After carotid artery balloon denudation, bortezomib was immediately administered by tail vein injection (systemic treatment) and by using an F-127 pluronic gel (perivascular treatment). Two weeks after the injury, we compared the degree of neointima formation in the carotid artery and the tissue expression patterns of NF-kappaB and I-kappaBalpha. RESULTS: The systemic treatment group exhibited a 29% reduction in neointima volume at two weeks after the balloon injury. On the western blot analysis, the bortezomib group exhibited an increased I-kappaBalpha expression, which suggested the inhibition of I-kappaBalpha degradation. On immunofluorescence analysis, the nuclear import of NF-kappaB was clearly decreased in the systemic bortezomib group. The perivascular bortezomib treatment group exhibited a significant reduction in the neointimal area (0.21+/-0.06 mm2 vs. 0.06+/-0.01 mm2, p<0.05), the neointima/media area ratio (1.43+/-0.72 vs. 0.47+/-0.16, p<0.05) and the % area stenosis (45.5+/-0.72% vs. 14.5+/-0.05%, p<0.05) compared with the control group. In situ vascular smooth muscle cell proliferation at 2 days after the injury was significantly inhibited (24.7+/-10.9% vs. 10.7+/-4.7%, p<0.05). CONCLUSION: Bortezomib suppressed NF-kappaB activation through the inhibition of I-kappaBalpha degradation, and significantly reduced neointima formation in a rat carotid artery injury model. These data suggested that bortezomib represented a new potent therapeutic agent for the prevention of restenosis.

Mechanisms of Platelet Activation and Integrin alphaIIbeta3

Platelet aggregation is not only an essential part of hemostasis, but also initiates acute coronary syndrome or ischemic stroke. The precise understanding of the activation mechanism of platelet aggregation is fundamental for the development of more effective agents against platelet aggregation. Adenosine diphosphate, thrombin, and thromboxane A2 activate platelet integrin alphaIIbbeta3 through G protein-coupled receptors. G protein-mediated signaling pathways, which are initiated by Gq, G12/G13 or Gi, include phospholipase C with calcium signaling, Rho signaling, protein kinase C and phosphatidylinositol 3-kinase. Rap1b, Ca2+ and diacylglycerol-regulated guanine nucleotide exchange factor I, Rap1-GTP-interacting adaptor molecule, and Akt are important proteins involved in G protein-mediated activation of integrin alphaIIbbeta3. Binding of talin-1 and kindlin-3 to cytoplasmic domains of beta3-integrin triggers a conformational change in the extracellular domains that increases its affinity for ligands, such as fibrinogen or von Willebrand factor. Fibrinogens act as bridges between adjacent platelets to generate a platelet aggregate.

Anti-Inflammatory Effects of Statins Beyond Cholesterol Lowering

No abstract available.

Expression of Lectin like Oxidized Low Density Lipoprotein Receptor-1 in the Spontaneous Hypertensive Rat with High Cholesterol Diet

BACKGROUND: Lectin-like, oxidized, low-density lipoprotein receptorreceptors (LOX-1) recognizes recognize vascular oxidized low-density lipoprotein (LDL), which may play an important role in the pathogenesis of atherosclerosis. We investigated the expressions expression of LOX-1 and redox-regulating thyoredoxinthioredoxin systems in a hypertension and hypercholesterolemia rat model. METHODS: Spontaneously hypertensive rats (SHR) and Wistar-Kyoto rat (WKY) rats were fed with a normal cholesterol diet (NC) and a high cholesterol diet (HC) for 4 weeks. Plasma LDL cholesterol levels and blood pressure were measured at 1 and 4 weeks. Histological changes of atherosclerosis in the vessel was evaluated by hematoxylin and eosin staining and immunocytochemistry. The expressions expression of LOX-1 and thyoredoixnthioredoxin were measured by Western western blot analysis. RESULTS: In the SHR groupsgroup, blood pressure after 4 weeks was significantly higher than initial levels. LDL-cholesterol levels in the SHR-HC group were increased at 4 weeks (15.3 +/- 2.6 mg/dL vs. 20.2 +/- 2.6 mg/dL, p < 0.01) compared with the SHR-NC group. In oxyblot analysis, the degree of oxidative stress of in the SHR-HC group was significantly higher than in the SHR-NC group (p < 0.05). The expressions expression of LOX-1 and Trx were was significantly increased in the SHR-HC group compared with the SHR-NC group (p < 0.05) on western blot analysis. Focal overexpressions overexpression of LOX-1 were was observed at the intima layer of the thoracic aorta, and was which wereonly observed in the SHR-HC group. CONCLUSIONS: The expressions expression of LOX-1 and oxidative stress were was significantly increased in the "hypertension with hypercholesterol" rat model. These findings suggested suggest that LOX-1 and redox systems may play a certain role in development and progression of atherosclerosis.

Digitalis (Cardiac Glycoside) Poisoning after Foxglove Ingestion: Case Report

Digoxin, also known as digitalis, is a purified cardiac glycoside extracted from the foxglove plant, Digitalis purpurea. Digoxin-mediated cardiac glycoside toxicity due to accidental plant ingestion can occur. Presently, a 69-year-old woman visited our emergency department with epigastric pain, nausea and vomiting after ingestion of a plant. Physical examination and initial laboratory blood test results were within normal limits. An electrocardiogram (ECG) showed sinus bradycardia with first degree AV block and diffuse ST-segment depressions in a "scooping" pattern. The plant was identified as D. purpurea, and the patient's serum digoxin level was 2.89 ng/mL. The patient was treated conservatively in the absence of any life-threatening event. Recovery was uneventful.

Aspirin Resistance in Patients with End-Stage Renal Disease / 대한신장학회지

PURPOSE: Patients with end-stage renal disease (ESRD) frequently undergo thrombotic cardiovascular events, but the relationship between increased thrombotic events and aspirin resistance is poorly defined in these patients. METHODS: Between December 2008 and November 2009, 59 ESRD patients who had taken aspirin alone or aspirin plus clopidogrel daily for > or =7 consecutive days were included. Aspirin resistance was measured using the VerifyNow Aspirin Assay and compared with that of patients with normal kidney function. Moreover, thrombotic cardiovascular events were examined in the ESRD patients. RESULTS: Aspirin reaction unit was 475+/-58 U in the ESRD patients compared with 443+/-62 U in patients with normal kidney function. Nineteen (11%) of 170 patients were aspirin resistant based on the criterion of aspirin reaction unit (> or =550). The prevalence of aspirin resistance was significantly higher in the ESRD patients than in control patients (20% vs. 6%, p=0.006). ESRD and the use of angiotensin- converting enzyme inhibitors were associated with aspirin resistance in the multivariate logistic regression analysis. After a mean follow-up of 18.6+/-7.5 months, the incidence of thrombotic cardiovascular events in the ESRD patients who had aspirin resistance was significantly higher than in the ESRD patients without aspirin resistance (75% vs. 38%, p=0.023). CONCLUSION: The incidence of aspirin resistance was higher in patients with ESRD than in patients with normal kidney function. In addition, ESRD and the use of angiotensin-converting enzyme inhibitors were significant predictors for aspirin resistance. Aspirin resistance was associated with increased thrombotic cardiovascular events in ESRD patients.

Very Late Stent Thrombosis after Drug-Eluting Stent Implantation in a Patient without Aspirin and Clopidogrel Resistance

Very late stent thrombosis (VLST) after implantation of drug-eluting stent is rare, but very fatal complication after percutaneous coronary intervention. We report a case of VLST of a sirolimus-eluting Cypher(TM) stent (Cordis, Johnson and Johnson) presenting as acute ST elevation myocardial infarction at 26 months after deployment with continued combined dual antiplatelet medication of aspirin and clopidogrel. The patient did not show anti-platelet resistance.

Re-endothelization and Inflammatory Reaction at Site of Overlapping Drug-Eluting Stents in a Porcine Coronary In-Stent Restenosis Model

BACKGROUND AND OBJECTIVES: This study was conducted to evaluate the inflammatory reaction at sites of overlapping stents in a porcine in-stent restenosis (ISR) model. MATERIALS AND METHODS: Twenty bare metal stents (BMS, Group I; n=10), 20 sirolimus-eluting stents (SES, Group II; n=10), 20 paclitaxel-eluting stents (PES, Group III; n=10), 10 PESs and 10 SESs (Group IV; n=10) were deployed and overlapped in the left anterior descending coronary arteries of 40 pigs. Follow-up coronary angiograms and histopathologic analysis were performed at 4 weeks after stenting. RESULTS: The minimal luminal diameter of the overlapped segment at 4 weeks was smaller in group I than that in the other groups (1.78+/-0.13 mm vs. 2.79+/-0.09 mm vs. 2.90+/-0.04 mm vs. 2.80+/-0.07 mm, respectively, p<0.001). The neointimal area (5.51+/-0.58 mm2 vs. 2.38+/-0.53 mm2 vs. 2.07+/-0.37 mm2 vs. 2.39+/-0.58 mm2, respectively, p<0.001) and the area stenosis (68.74+/-4.02% vs. 27.79+/-4.73% vs. 23.66+/-3.24% vs. 27.63+/-4.07%, respectively, p<0.001) of the overlapped segment were significantly higher in Group I than that in the other groups. The inflammatory score of the overlapped segment was significantly higher in Group III than that in the other groups (1.80+/-0.42 vs. 2.10+/-0.32 vs. 2.90+/-0.31 vs. 2.50+/-0.52, respectively, p<0.001). The endothelization score of the overlapped segment was significantly lower in Group III than that in the other groups (2.80+/-0.42 vs. 2.30+/-0.67 vs. 1.30+/-0.48 vs. 2.10+/-0.74, respectively, p<0.001). CONCLUSION: Compared with the BMS, the DES inhibits neointimal hyperplasia, but inflammation and poor endothelization are observed at the sites of overlapped stents.

Plasma Thioredoxin Level and Its Correlation to Myocardial Damage in Patients with Acute Myocardial Infarction who Underwent Successful Primary Angioplasty

BACKGROUND AND OBJECTIVES: Oxidative stress is thought to play important role in cardiovascular disease. Thioredoxin is an important biomarker for determining the degree of oxidative stress. However, the relationship between the plasma thioredoxin levels and myocardial damage has not been investigated. SUBJECTS AND METHODS: We measured the plasma thioredoxin levels in the patients suffering with acute myocardial infarction and who also underwent successful primary angioplasty. We then compared the plasma thioredoxin levels and the clinical parameters in acute myocardial infarction patients (n=37) in order to examine the relationship between oxidative stress and myocardial damage. RESULTS: The plasma thioredoxin level was significantly related with the initial WBC count (r=0.349, p<0.05) and the myocardial damage, the peak CK level (r=0.489, p<0.01), the CK increment (r=0.452, p<0.05), the peak MB level (r=0.417, p<0.05), and the MB increment (r=0.364, p<0.05). We divided the patients into two groups according to the plasma thioredoxin levels. There was a significant difference in myocardial damage between the low and high plasma thoiredoxin levels at the initial WBC count (10174.2+/-3380.4/uL vs 13500+/-3740.7/uL, respectively; p<0.01) and the cardiac enzyme, the peak CK level (2565.2+/-1389.9 IU/L vs 4045.9+/-1978.9 IU/L, respectively; p=0.02), the CK increment (2309.6+/-1351.8 IU/L vs 3762.8+/-2079.7 IU/L, respectively; p=0.03), the peak MB level (208.7+/-127.5 IU/L vs 322.7+/-146.3 IU/L, respectively; p=0.02), and the MB increment (173.8+/-128.4 IU/L vs 277.7+/-158.9 IU/L, respectively; p=0.05). CONCLUSION: High thioredoxin levels were associated with the degree of oxidative stress and the extent of myocardial damage. Thioredoxin levels may be used as a new surrogate biomarker for the severity of oxidative stress and the extent of myocardial damage in the patients suffering with acute myocardial infarction.