CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 1, January – April 2024 AFRICA 37 Results Baseline characteristics of the study population are presented in Table 1. The average age was 61 ± 11.35 years and 61.11% of the patients were male. The median value of the apelin-12 level was 4.65 ng/ml (0.46–15.25), while the median value of CK-MB was 163.5 IU/l (15.0–929.0). Other baseline characteristics are presented as mean, median and percentage. In patients with TIMI flow ≤ 2, the median of the apelin-12 level was 1.80 ng/ml (0.46–9.2), and with TIMI flow 3, it was 5.76 ng/ml (1.14–15.2). Variability was observed in the apelin values (Mann–Whitney test) based on TIMI flow grade (p < 0.001), while no variability was observed for CK-MB levels (p < 0.18) (Table 2). The degree of association between apelin-12 and CK-MB was analysed with Pearson’s correlation, predicting patients with successful reperfusion (TIMI flow 3) (p < 0.004), and those with unsuccessful reperfusion (TIMI flow ≤ 2) (p = 0.86). Fig. 2 shows the correlation between apelin-12 and CK-MB levels in patients with TIMI flow grade 3, while Fig. 3 shows this correlation in patients with TIMI flow grade ≤ 2. Discussion Our study was conducted to investigate the association of apelin-12 and CK-MB levels with success of reperfusion (TIMI flow 3 or ≤ 2) in patients with STEMI. During acute myocardial infarction, apelin-12 showed a protective effect in unsuccessful reperfusion, and a high level of apelin-12 resulted in better TIMI flow. Among the subgroup of patients with successful reperfusion (TIMI flow 3), a positive correlation was observed between increased levels of apelin-12 and increased activity of CK-MB. Cardiomyocytes are highly oxidative cells where the mitochondria are located at the site of high ATP demand, and together with myofilaments and sarcoplasmic reticulum, they create intracellular energetic units around the sarcomeres.29 In the cardiomyocytes, ischaemia and hypoxia represent acute crises of energy provision, followed by increased activity of CK, which catalyses the phosphoryl exchange between ADP and CK. According to a previous study, CK structurally associates with 1 000 800 600 400 200 0 Creatine kinase-MB Apelin-12 0 2 4 6 8 10 y = 1.84E2 + –2.87+x Fig. 3. Correlation between apelin-12 levels and CK-MB activity in patients with TIMI flow ≤ 2. 1 000 800 600 400 200 0 Creatine kinase-MB Apelin-12 0 5 10 15 20 y = 58.49 + 26.6+x Fig. 2. Correlation between apelin-12 levels and CK-MB activity in patients with TIMI flow 3. Table 1. Baseline characteristics of patients Characteristics Results Age (years) 61.02 ± 11.35 Gender (male) 44 (61.11) Coronary risk factors Hypertension 44 (61.11) Diabetes mellitus 16 (22.22) Dyslipidaemia 32 (44.44) Smoking 32 (44.44) Family history of cardiovascular disease 20 (27.77) Killip class > 1 13 (18.05) Ejection fraction 50.87 ± 10.9 Laboratory values Haemolobin (g/dl) 13.68 ± 1.51 Creatinine (μmol/l) 94.0 (67.21–125.34) Apelin 12 (ng/ml) 4.65 (0.46–15.25) Creatine kinase-MB (IU/l) 163.5 (15.0–929.0) Creatine kinase (IU/l) 1414.0 (42.0–7550.0) Troponin I (ng/ml) 42.89 ± 59.37 Coronary angiographic findings Culprit lesion RCA 30 (41.66) LAD 31 (43.05) LCx 11 (15.27) Data are expressed as a mean ± standard deviation, median (range) and n (%). RCA, right coronary artery; LAD, left coronary artery; LCx, left circumflex artery. Table 2. Comparison of different laboratory variables between patients with TIMI flow ≤ 2 and 3 Variable TIMI flow ≤ 2 TIMI flow 3 p-value Apelin-12 (ng/ml) 1.8 (0.46–9.2) 5.76 (1.14–15.2) < 0.001 Creatine kinase-MB (IU/l) 145.0 (16.0–929.0) 171.5 (15.0–910.0) 0.18 Creatine kinase (IU/l) 1640.0 (57.0–4316.0) 1351.0 (42.0–7550.0) 0.9 Troponin I (ng/ml) 78.27 ± 68.94 25.21 ± 45.17 < 0.001 Haemolobin (g/dl) 13.53 ± 1.95 13.75 ± 1.25 0.32 Creatinine (μmol/l) 91.5 (70.0–124.0) 95.0 (67.21–125.34) 0.51 Data are expressed as a mean ± standard deviation or median (range). TIMI, thrombolysis in myocardial infarction.
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