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Apoptosis kinetics at reperfusion period in patients with acute ST-Segment Elevation Myocardial Infarction undergoing
Nazmi Gultekin1, Gulsum Bulut1, Emine Kucukates2
1Department of Cardiology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey.
Insights
Reperfusion injury in ST-segment elevation myocardial infarction is a slow, benign event not primarily linked to cardiomyocyte apoptosis. Percutaneous coronary intervention showed no negative impact on reperfusion injury.
Area of Science:
- Cardiology
- Cellular Biology
- Biochemistry
Background:
- Reperfusion injury is a complex process following restoration of blood flow to ischemic tissues.
- Understanding the role of cardiomyocyte apoptosis in reperfusion injury is crucial for optimizing treatment strategies in myocardial infarction.
Purpose of the Study:
- To investigate the temporal dynamics of cardiomyocyte apoptosis following reperfusion in ST-segment elevation myocardial infarction (STEMI).
- To compare the effects of primary percutaneous coronary intervention (PCI) versus thrombolytic therapy on reperfusion injury-induced apoptosis.
- To determine the relationship between apoptotic activity and cardiac biomarker levels after reperfusion.
Main Methods:
- A prospective descriptive study involving 92 patients with STEMI, divided into PCI (Group 1) and thrombolytic therapy (Group 2) groups.
- Cardiomyocyte apoptosis was assessed using a cell death detection ELISA kit at baseline and at 6, 12, 24, and 72 hours post-reperfusion.
- Cardiac biomarkers including creatine kinase, peak creatine kinase-myocardial band, and troponin levels were measured.
Main Results:
- Apoptotic activity significantly increased at 72 hours compared to baseline in both PCI and thrombolytic therapy groups (p<0.001).
- No significant correlation was found between peak apoptotic activity at 72 hours and peak creatine kinase-myocardial band or troponin levels at 24 hours.
- PCI did not demonstrate a negative impact on reperfusion injury in this cohort.
Conclusions:
- Reperfusion injury in STEMI is a slowly progressive and generally benign event, not primarily driven by cardiomyocyte apoptosis.
- The findings suggest that apoptosis plays a limited role in the acute phase of reperfusion injury in STEMI patients.
- Primary PCI appears safe concerning reperfusion injury, with no discernible negative effects observed in this study.
Objective:
To evaluate the kinetics of cardiomyocyte apoptosis in patients undergoing primary percutaneous coronary intervention and thrombolytic therapy in order to elucidate the dark side of reperfusion injury.
Methods:
The prospective descriptive study was conducted at Istanbul University Cardiology Institute, Istanbul, Turkey, between June 2010 and December 2012. It comprised patients with persistent ST-segment elevation myocardial infarction who were divided into two groups. Patients in group 1 were treated with percutaneous coronary intervention, while those in group 2 received thrombolytic therapy. Cell death detection enzyme-linked immunosorbent assay kit was used for the analysis of cardiomyocyte apoptosis. Venous blood samples were collected to determine the apoptotic activity from the patients at the beginning of thrombolysis in myocardial infarction grade 3 of reperfusion in infarct-related artery according to thrombolysis in myocardial infarction classification, and after reperfusion provided at 6, 12, 24 and 72 hours. Creatine kinase, peak creatine kinase myocardial band and troponin levels were determined on admission and during 24hours of ST-segment elevation myocardial infarction . SPSS 15 was used for statistical analysis.
Results:
There were 92 patients in the study; 48(51.6%) in group 1 and 44(48.4%) in group 2.There was no significant correlation between peak apoptotic activity levels at 72 hours of reperfusion and peak creatine kinase myocardial band (r=0.05;p=0.66) or the troponin (r=0.10;p=0.38) levels at 24 hours of ST-segment elevation myocardial infarction. Apoptotic activity levels increased at 72 hours compared to the baseline both for group 1 (p<0.001) and group 2(p<0.001).
Conclusions:
Reperfusion injury was not primarily related to apoptosis and it was a slowly progressive benign event in patients with ST-segment elevation myocardial infarction-acute coronary syndrome. Also, the negative impact of percutaneous coronary intervention was not available on reperfusion injury.
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