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Altered serum creatine kinase level and cardiac function in ischemia-reperfusion injury during percutaneous coronary
Yi Luo1, Yi-Zhi Pan, Chong Zeng
1Department of Cardiology, Guangzhou 1st People's Hospital Affiliated to Guangzhou Medical College, Guangzhou, Guangdong, China. yiluo63@yahoo.com.cn
Insights
Myocardial ischemia-reperfusion injury (MIRI) after primary PCI for acute myocardial infarction (AMI) increases mortality, particularly the no-reflow type. However, suppression- and irritation-type MIRI may indicate surviving heart muscle.
Area of Science:
- Cardiology
- Biochemistry
- Clinical Medicine
Background:
- Myocardial ischemia-reperfusion injury (MIRI) following primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) poses risks, but its clinical impact is not fully understood.
- This study investigates the association between cardiac function (echocardiography) and serum biomarkers (creatine kinase [CK] and CK-MB) with MIRI in Chinese AMI patients.
Purpose of the Study:
- To explore the clinical significance of MIRI in acute myocardial infarction (AMI) patients undergoing primary PCI.
- To determine the relationship between echocardiographic parameters and serum CK/CK-MB levels with different types of MIRI.
Main Methods:
- Retrospective analysis of clinical and angiographic data from 228 AMI patients treated with primary PCI.
- Echocardiography was used to assess cardiac function before hospital discharge.
Main Results:
- In-hospital mortality was significantly higher in the MIRI group (13.4%) compared to the non-MIRI group (4.6%).
- No-reflow-type MIRI was associated with higher peak serum CK and CK-MB levels and reduced left ventricular ejection fraction.
- Suppression-type MIRI showed lower peak CK levels, while irritation-type MIRI had no significant difference in CK/CK-MB levels compared to non-MIRI.
Conclusions:
- MIRI, especially the no-reflow type, is linked to adverse hemodynamic changes and increased mortality in AMI patients.
- Suppression- and irritation-type MIRI might suggest the presence of viable myocardium, warranting further investigation.
Background:
Myocardial ischemia-reperfusion injury (MIRI) resulting from primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) is considered harmful to the patient, but its clinical significance remains unclear. This study explored the relationship of cardiac function examined by echocardiography and serum creatine kinase (CK) and CK-MB levels with MIRI in a cohort of Chinese AMI patients.
Material/Methods:
We retrospectively analysed the clinical and angiographic data in 228 AMI patients in whom the infarct-related artery (IRA) was successfully recanalized by primary PCI. Cardiac function was evaluated by use of echocardiography before discharge from hospital.
Results:
The in-hospital mortality rate in the MIRI group was 13.4% (16/119), which was significantly higher than the 4.6% (5/109) mortality rate in the non-MIRI group (P=0.021). The median of peak serum CK level was remarkably lower in the suppression-type MIRI group than in the non-MIRI group. There were no significant differences in the peak serum CK or CK-MB levels between the irritation-type MIRI group and the non-MIRI group. The peak CK and CK-MB levels were significantly higher in the no-reflow-type MIRI group than in the non-MIRI group. Left ventricular ejection fraction in the no-reflow-type MIRI group was significantly lower than in the non-MIRI group; left ventricular end-diastolic volume was significantly higher than in the irritation-type MIRI subgroup; and left ventricular end-systolic volume was greater than that in non-MIRI group and suppression-type MIRI group.
Conclusions:
MIRI (especially the no-reflow type) may lead to acute hemodynamic disorders and increase the mortality rate. However, suppression- and irritation-type MIRI may imply the existence of surviving myocardium.
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