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Endothelin-1 and acute myocardial infarction: a no-reflow mediator after successful percutaneous myocardial
Giampaolo Niccoli1, Gaetano Antonio Lanza, Sidney Shaw
1Institute of Cardiology, Catholic University of the Sacred Heart, 00168 Rome, Italy. gniccoli73@hotmail.it
Insights
Elevated Endothelin-1 (ET-1) plasma levels predict no-reflow after primary percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) patients. This suggests ET-1 antagonists may help manage no-reflow complications.
Area of Science:
- Cardiology
- Vascular Biology
- Biochemistry
Background:
- No-reflow after primary percutaneous coronary intervention (PCI) is linked to left ventricular (LV) failure and poor prognosis.
- Endothelin-1 (ET-1), a vasoconstrictor peptide, modulates neutrophil function and its elevated levels predict poor prognosis in acute myocardial infarction (AMI) patients undergoing primary PCI.
Purpose of the Study:
- To investigate the association between systemic ET-1 plasma levels and the occurrence of no-reflow in AMI patients treated with primary PCI.
Main Methods:
- The study included 51 patients with first AMI undergoing successful primary or rescue PCI.
- No-reflow was defined by coronary TIMI flow grade ≤2 or TIMI flow 3 with myocardial blush grade ≤2.
- ET-1 plasma levels were measured on admission; logistic regression analyzed predictors of no-reflow.
Main Results:
- No-reflow occurred in 61% of patients (31 out of 51).
- Higher ET-1 plasma levels (3.95±0.7 vs. 3.3±0.8 pg/mL, P=0.004) and culprit lesion in the left anterior descending artery (LAD) were associated with no-reflow.
- Multivariable analysis identified ET-1 as the sole significant predictor of no-reflow (P=0.03), alongside LAD as the culprit vessel (P=0.04).
Conclusions:
- Systemic ET-1 plasma levels are predictive of angiographic no-reflow following successful primary or rescue PCI.
- These findings indicate that ET-1 antagonists could potentially be beneficial in managing no-reflow complications.
Aims:
No-reflow after a primary percutaneous coronary intervention (PCI) is associated with a high incidence of left ventricular (LV) failure and a poor prognosis. Endothelin-1 (ET-1) is a potent endothelium-derived vasoconstrictor peptide and an important modulator of neutrophil function. Elevated systemic ET-1 levels have recently been reported to predict a poor prognosis in patients with acute myocardial infarction (AMI) treated by primary PCI. We aimed to investigate the relationship between systemic ET-1 plasma levels and no-reflow in a group of AMI patients treated by primary PCI.
Methods And Results:
A group of 51 patients (age 59+/-9.9 years, 44 males) with a first AMI, undergoing successful primary or rescue PCI, were included in the study. Angiographic no-reflow was defined as coronary TIMI flow grade < or =2 or TIMI flow 3 with a final myocardial blush grade < or =2. Blood samples were obtained from all patients on admission for ET-1 levels measurement. No reflow was observed in 31 patients (61%). Variables associated with no-reflow at univariate analysis included culprit lesion of the left anterior coronary descending artery (LAD) (67 vs. 29%, P=0.006) and ET-1 plasma levels (3.95+/-0.7 vs. 3.3+/-0.8 pg/mL, P=0.004). At multivariable logistic regression analysis, ET-1 was the only significant predictor of no-reflow (P=0.03) together with LAD as the culprit vessel (P=0.04).
Conclusion:
ET-1 plasma levels predict angiographic no-reflow after successful primary or rescue PCI. These findings suggest that ET-1 antagonists might be beneficial in the management of no-reflow.
