الفهرس 
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Abstract
Background: AMI is a leading cause of death associated with CAD globally. AMI is caused by the rupture or erosion of a susceptible atherosclerotic plaque, which results in coronary artery blockage and progressive cell death. AMI is classified into two types based on ECG results: STEMI and NSTEMI. STEMI is produced by transmural ischemia, or ischemia that affects the whole thickness of the myocardium, but NSTEMI does not. STEMI is the most severe type of coronary artery disease, with high morbidity and death that must be diagnosed as quickly as possible, ideally within 10 minutes after the patient’s first medical contact. Angiogenesis contributes to the post-MI healing process by re-establishing microvascular circulation and supplying nutrient- and oxygen-rich blood to the cardiac tissue. Members of the VEGF family, notably VEGF-A, play an important role in post-MI angiogenesis. VEGF enhances endothelial cell survival, proliferation, and migration, as well as the formation of collaterals. Which improves heart function by increasing myocardial perfusion and decreasing infarct size. Endogenous VEGF-A levels are significantly higher in STEMI patients, according to research and they hypothesized that pharmacologically modifying VEGF-A expression and activity would be a possible therapeutic approach to hasten angiogenesis after AMI, emphasizing its function post-AMI. VEGF A gene polymorphism (rs2010963) has been studied in CAD patients of many populations but up to our knowledge, it has not been explored in Egyptian ethnicity. In our study we aimed to Assess the level of VEGF-A as a diagnostic marker in acute STEMI and explore the relationship between the VEGF-A gene (rs2010963) polymorphism and the risk of STEMI and whether it has effect on clinical outcome within six months. Objective: Our Study aimed to assess the level of VEGF-A in acute STEMI, explore the relationship between the VEGF-A gene (rs2010963) polymorphism and the risk of STEMI and whether it has effect on clinical outcome within six months. Study locality: Cardiology Department and Intensive Care unit of Specialized Internal Medicine Hospital, Mansoura University. Laboratory work was held Clinical Pathology Department laboratories and molecular laboratory of oncology center in Mansoura faculty of medicine. Study Period: The study had been conducted within a year from January 2022 to January 20223. Study design: The study was a case-control pilot study. Study population: The study was conducted on two groups; the patient group included 50 STEMI patients and the control group included 50 apparently healthy subjects, that were age and sex matched and living in the same area and environment as patients. Methods: Patients and controls were subjected to the following :full clinical examination and brief history taking, ECG (patients only) and Echocardiogram (patients only), all patients and controls were subjected to the following investigations: Creatinine, lipid profile and Cardiac markers (total CK and CK-MB),VEGF-A (Vascular Endothelial Cell Growth Factor) level and Genetic study: Real Time-PCR for the selected SNP VEGF-A (rs2010963). Results: VEGF-A level is higher in STEMI cases vs. control at baseline, and in STEMI cases at 2-weeks vs. baseline. VEGF-A at a cut off value > 20 pg/ml is a statistically significant discriminator of STEMI cases vs. control with a good diagnostic accuracy [AUC (95% CI) = 0.785 (0.692-0.861), SE = 0.046]. Regarding VEGF-A (rs2010963): The G` allele is risky for STEMI, Participants with C/G-G/G genotypes have 2.8-times higher odds (adjusted for age and sex) vs. those with C/C genotype to exhibit STEMI, C/G genotype is associated with highest VEGF-A level and STEMI participants with C/G genotype have 4.3-times higher odds vs. those with C/C-G/G genotype to exhibit poor outcome. Conclusion: Determination of VEGF-A level might be accurate in discriminating STEMI cases from control. VEGF-A (rs2010963) gene polymorphism is a functional SNP that affect VEGF-A level, associated with risk of developing STEMI and specific genotypes have more effect on the clinical outcome within six months. Key words: VEGF-A, STEMI, Polymorphism .