Purines and oxypurines in myocardial ischemia

OBJECTIVE: To evaluate the plasma levels of purine nucleosides and oxypurines in the presence of other risk factors as additional markers for the diagnosis of myocardial ischemia and severity of myocardial infarction.

METHODS: A case control study was conducted on 101 patients with ischemic heart disease (stable angina, n=19: unstable angina, n=29: acute myocardial infarction [AMI]; n=53 patients) admitted to the Cardiology Unit at Al-Kadhimyia Teaching Hospital, Baghdad, Iraq from January to November 2007 in addition to 31 healthy controls. Blood samples were aspirated from those with AMI within the first 12 hours of onset of chest pain. Plasma adenosine (ADO), inosine (INO), hypoxanthine (HYP), and xanthine (XAN) were analyzed by high-performance liquid chromatography.

RESULTS: The mean plasma ADO, INO, HYP, and XAN levels were raised in unstable angina over the control values. More increase in all nucleosides and oxypurines was reported in the plasma of patients with AMI as compared to the controls and those of stable angina. The INO (p=0.01) and HYP (p=0.001) values were increased significantly in diabetic men with AMI and at age of </= 54 years. The mean uric acid values were significantly elevated in hypertensives with unstable angina and smokers with stable angina.

CONCLUSION: The levels of purines and their catabolites could be used as additional indices for prior or current ischemia. Pretreatment with such nucleosides, or their oxypurine derivatives, is suggested to improve the regional ventricular function after coronary artery occlusion.