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Published on: June 28, 2019
Effect of hemorheological parameters on myocardial injury after primary or elective percutaneous coronary
Francesco Fracassi1, Vincenzo Vetrugno1, Alessandro Mandurino-Mirizzi1
1Institute of Cardiology, Catholic University of the Sacred Heart.
Insights
Abnormal blood viscosity, including higher blood viscosity (η) and erythrocyte aggregation index, is linked to microvascular obstruction and myocardial necrosis during percutaneous coronary intervention (PCI). These factors may also predict adverse cardiovascular events.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Interventional Cardiology
Background:
- Abnormal blood viscosity is implicated in atherosclerosis development due to endothelial dysfunction and altered shear stress.
- The specific impact of blood viscosity on coronary microvasculature during percutaneous coronary intervention (PCI) remains largely unknown.
- Understanding hemorheological parameters is crucial for assessing risks associated with PCI procedures.
Purpose of the Study:
- To investigate the role of hemorheological parameters in microvascular obstruction (MVO) and periprocedural necrosis following PCI.
- To evaluate the prognostic significance of hemorheological parameters for major adverse cardiovascular events (MACE) after PCI.
Main Methods:
- Enrolled 25 ST-elevation myocardial infarction (STEMI), 30 non-ST-elevation myocardial infarction (NSTEMI), and 30 stable angina (SA) patients undergoing PCI.
- Assessed MVO and periprocedural necrosis using angiographic, electrocardiographic, and laboratory methods.
- Measured hemorheological profile including blood viscosity (η) at shear rates 200 s⁻¹ and 1 s⁻¹, erythrocyte aggregation index (η1/η200), and plasma viscosity.
Main Results:
- Patients with STEMI experiencing MVO showed significantly higher blood viscosity at 200 s⁻¹ (η200).
- Patients with SA and NSTEMI experiencing periprocedural necrosis had higher η200, η1, and η1/η200 values.
- Elevated η200 was associated with a higher incidence of MACE at 30-month follow-up.
Conclusions:
- Hemorheological parameters, particularly blood viscosity, are significantly associated with MVO and periprocedural necrosis in patients undergoing PCI.
- These findings suggest that hemorheological status may contribute to myocardial injury and predict unfavorable outcomes after PCI.
- Further confirmation is needed to fully establish the prognostic value of hemorheological parameters in this context.
Background:
Abnormal blood viscosity favors atherosclerosis owing to endothelial dysfunction and changes in shear stress. Its effect on coronary microvasculature during percutaneous coronary intervention (PCI) is still unknown. We aimed to investigate the role of hemorheological parameters in the incidence of microvascular obstruction (MVO) and the periprocedural necrosis after primary or elective PCI, and secondarily, we evaluated their prognostic significance.
Materials And Methods:
We enrolled 25 patients with ST-elevation myocardial infarction (STEMI), 30 patients with non-ST-elevation myocardial infarction (NSTEMI), and 30 patients with stable angina (SA) undergoing PCI. MVO in patients with STEMI and periprocedural necrosis in patients with NSTEMI and those with SA were assessed using angiographic/electrocardiographic and laboratory methods, respectively. Hemorheological profile included blood viscosity (η) at shear rates 200 s and 1 s, the erythrocyte aggregation index (η1/η200), and plasma viscosity. Major adverse cardiovascular events occurrence was evaluated at follow-up.
Results:
Patients with STEMI experiencing angiographic MVO (28%) had higher η200 (5.42±1.28 vs. 3.98±1.22 mPa[BULLET OPERATOR]s; P=0.015). Similarly, patients with STEMI experiencing electrocardiographic MVO (56%) had higher η200 (4.58±0.36 vs. 3.94±0.19 mPa[BULLET OPERATOR]s; P<0.001). Among patients with SA and patients with NSTEMI, those experiencing periprocedural necrosis (23.3%) had higher η200 (5.30±0.86 vs. 4.37±0.88 mPa[BULLET OPERATOR]s; P=0.001), η1 (19.52±9.62 vs. 13.29±7.65 mPa[BULLET OPERATOR]s; P=0.015) and η1/η200 values (3.64±1.50 vs. 2.72±0.92; P=0.007). These significant differences were maintained after adjustment for age, sex, and cardiovascular risk factors. At follow-up (30±6 months), 25 (29.4%) patients presented major adverse cardiovascular events, and they had higher η200 (5.18±1.00 vs. 4.25±1.01 mPa[BULLET OPERATOR]s; P<0.001).
Conclusion:
In patients undergoing either urgent or elective PCI, hemorheological parameters might contribute to myocardial injury and, if furtherly confirmed, to an unfavorable outcome.
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