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Soluble endothelial protein C receptor levels and protein C activity in patients with acute ST-segment elevation myocardial infarction

Tanalp, Ali C.a; Oduncu, Vecihb; Erkol, Ayhane; Gözübüyük, Gökhanf; Ozveren, Olcayc; Dündar, Cihang; Canbay, Alpera; Kirma, Cevatd

doi: 10.1097/MCA.0b013e32835e5c45
Diagnostic Methods

Objectives In contrast to its membrane-bound form, soluble endothelial protein C receptor (sEPCR) expresses procoagulant activity through binding to protein C. We aimed to investigate the relationship between sEPCR levels and protein C activity in patients with ST-segment elevation myocardial infarction (STEMI).

Methods The study population included 60 STEMI patients who had undergone a primary percutaneous coronary intervention and 29 patients with stable angina pectoris (SAP) with significant coronary stenosis on angiography. Preprocedural sEPCR levels and protein C activity were determined in all study patients.

Results In the STEMI group, the baseline sEPCR level was significantly higher (172.0±89.3 vs. 107.1±39.2 ng/ml, P<0.001) and protein C activity was significantly lower (91.9±26.4 vs. 124.5±16.2%, P<0.001) compared with patients with SAP. There was a significant negative correlation between protein C activity and sEPCR in the STEMI group (r=−0.38, P=0.002); however, no significant correlation was observed in the SAP group (r=0.02, P=0.91). Angiographic thrombus load and the incidence of no-reflow phenomenon were significantly higher in STEMI patients with protein C activity under the median level.

Conclusion The ratio of sEPCR levels to protein C activity is high, with a significant negative correlation in patients with STEMI. Lower protein C activity is associated with the development of no-reflow in STEMI patients. However, the sEPCR level has no relation to the development of no-reflow. The clinical significance of elevated sEPCR level in STEMI should be evaluated in larger studies.

aDepartment of Cardiology, Medicana International Hospital, Ankara

bDepartment of Cardiology, Fatih Medikal Park Hospital

cDepartment of Cardiology, Yeditepe University Hospital

dDepartment of Cardiology, Kosuyolu Heart Education and Research Hospital, İstanbul

eDepartment of Cardiology, Kocaeli Derince Education and Research Hospital, Kocaeli

fDepartment of Cardiology, Malatya State Hospital, Malatya

gDepartment of Cardiology, Samsun Education and Research Hospital, Samsun, Turkey

This work was carried out at the Kartal Kosuyolu Heart Education and Research Hospital.

Correspondence to Ayhan Erkol, MD, Kocaeli Derince Eğitim ve Araştirma Hastanesi, Kardiyoloji Kliniği, İbni Sina Bulvari, 41900 Derince/Kocaeli, Turkey Tel: +90 262 317 8001; fax: +90 262 233 5540; e-mail:

Received July 24, 2012

Accepted December 23, 2012

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins