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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Cell-free DNA and Microvascular Damage in ST-segment Elevation Myocardial Infarction Treated With Primary
Juan Sanchis1, Sergio García-Blas1, Luis Ortega-Paz2
1Servicio de Cardiología, Hospital Clínico Universitario, Instituto de Investigación Sanitaria INCLIVA, Universidad de Valencia, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Valencia, Spain.
Insights
A small cell-free DNA (cfDNA) gradient in ST-segment elevation myocardial infarction indicates higher coronary cfDNA levels. This is linked to poorer ST-segment resolution after angioplasty.
Area of Science:
- Cardiology
- Biochemistry
- Molecular Biology
Background:
- Cell-free DNA (cfDNA) in ST-segment elevation myocardial infarction (STEMI) may originate from activated leukocytes at the coronary lesion.
- Investigating cfDNA's role in coronary reperfusion is crucial for understanding STEMI outcomes.
Purpose of the Study:
- To explore the association between cfDNA and coronary reperfusion in STEMI patients.
- To determine if cfDNA levels predict reperfusion success after primary angioplasty.
Main Methods:
- 116 STEMI patients undergoing primary angioplasty with thrombus aspiration were studied.
- Coronary and peripheral blood samples were analyzed for cfDNA, troponin T, and myeloperoxidase.
- Primary endpoint: no ST-segment resolution (STR) (≥70%); secondary endpoint: lack of final Thrombolysis In Myocardial Infarction (TIMI) 3 flow.
Main Results:
- A smaller peripheral-coronary cfDNA gradient was observed in patients with no STR and no TIMI 3 flow (P=.02 and P=.04).
- A small cfDNA gradient (<1.82 ng/mL) predicted a higher rate of no STR (65% vs 30%; P=.001) and lack of TIMI 3 flow (21% vs 3%; P=.05).
- Multivariable analysis confirmed small cfDNA gradient as a predictor of no STR (OR, 4.50; P=.004).
Conclusions:
- A reduced peripheral-coronary cfDNA gradient suggests a high coronary cfDNA burden, associated with failed ST-segment resolution in STEMI.
- Intracoronary cfDNA may indicate neutrophil activation, potentially impacting thrombus aspiration efficacy.
- Further research is needed to confirm if this cfDNA phenomenon contributes to thrombus aspiration failure.
Introduction And Objectives:
Cell-free DNA (cfDNA) in ST-segment elevation myocardial infarction might originate from hyperactivated leukocytes at the coronary lesion. Our aim was to investigate the relationship between cfDNA and coronary reperfusion.
Methods:
We studied 116 patients treated with primary angioplasty using thrombus aspiration. Coronary (during aspiration) and peripheral (at the end of the procedure) blood samples were drawn for cfDNA, as well as high-sensitivity troponin T and myeloperoxidase quantification. The primary endpoint was no ST-segment resolution (STR) (≥ 70%) and the secondary endpoint was lack of final Thrombolysis In Myocardial Infarction flow 3 (TIMI 3).
Results:
ST-segment resolution was achieved in 51 (44%) patients and TIMI 3 flow in 97 (84%). Patients without STR and TIMI 3 flow had a smaller peripheral-coronary cfDNA gradient (P = .02 and P = .04 respectively). A small cfDNA gradient (< 1.82 ng/mL) was associated with a higher rate of no STR (65% vs 30%; P = .001) and lack of TIMI 3 flow (21% vs 3%; P = .05). After multivariable adjustment, the small cfDNA gradient was predictive of no STR (OR, 4.50; 95%CI, 1.60-12.62; P = .004), while there was a nonsignificant trend for final TIMI 3 flow (P = .14). Cell-free DNA levels did not correlate with troponin T or myeloperoxidase.
Conclusions:
A small peripheral-coronary cfDNA gradient, as an expression of high coronary cfDNA burden, is associated with no STR in acute myocardial infarction. Intracoronary cfDNA might reflect neutrophil activation. Whether this phenomenon contributes to thrombus aspiration failure requires further study.
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