title: A combination of increased Rho kinase activity and N-terminal pro-B-type natriuretic peptide predicts worse cardiovascular outcome in patients with acute coronary syndrome.
abstract: BACKGROUND
  Recent experimental evidence suggests that the Rho/Rho-kinase (ROCK) system may play an important role in the pathogenesis of acute coronary syndrome (ACS) but there are little clinical data. This study examined if ROCK activity is increased in patients with acute coronary syndrome and if ROCK activity predicts long-term cardiovascular event.
  
  
  METHODS
  Blood samples were collected from 188 patients within 12h after admission for ACS (53% men; aged 70 ± 13) and from 61 control subject. The main outcome measures were all cause mortality, readmission with ACS or congestive heart failure (CHF) from presentation within around 2 years (mean:14.4 ± 7.2 months; range: 0.5 to 26 months).
  
  
  RESULTS
  ROCK activity increased in ST elevation myocardial infarction (STEMI, n=90) (3.33 ± 0.93), non-STEMI (NSTEMI, n=68) (3.37 ± 1.04) and unstable angina (UA, n=30) (2.53 ± 0.59) groups when compared with disease controls (n=31) (2.06 ± 0.38, all p<0.001) and healthy controls (n=30) (1.54 ± 0.43, all p<0.001). There were 24 deaths, 34 readmissions with ACS and 15 admissions with CHF within 2 years. Patients with a high N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high ROCK activity on admission had a five-fold risk of a cardiovascular event (RR: 5.156; 95% CI: 2.180-12.191) when compared to those with low NT-proBNP and low ROCK activity.
  
  
  CONCLUSIONS
  ROCK activity was increased in patients with ACS, particularly in those with myocardial infarction. The combined usage of both ROCK activity and NT-proBNP might identify a subset of ACS patients at particularly high risk.
authors.affiliation: Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Peoples' Republic of China.
authors.forename: Ming
authors.initials: M
authors.lastname: Dong
authors.forename: James K
authors.initials: JK
authors.lastname: Liao
authors.forename: Bryan
authors.initials: B
authors.lastname: Yan
authors.forename: Ruijie
authors.initials: R
authors.lastname: Li
authors.forename: Mang
authors.initials: M
authors.lastname: Zhang
authors.forename: Cheuk-Man
authors.initials: CM
authors.lastname: Yu
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000175:diagnosis*; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D004789:Enzyme Activation / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome; D054460:rho-Associated Kinases / Q000097:blood*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D054460:rho-Associated Kinases