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Published on: May 28, 2019
Vitamin D deficiency is associated with impaired reperfusion in STEMI patients undergoing primary percutaneous
Monica Verdoia1, Filippo Viglione2, Annalisa Boggio3
1Division of Cardiology, Ospedale degli Infermi, ASL Biella, Biella, Italy.
Insights
Low vitamin D levels in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI) are linked to poorer epicardial reperfusion. This highlights a potential role for vitamin D in STEMI outcomes.
Area of Science:
- Cardiology
- Endocrinology
- Biochemistry
Background:
- Vitamin D has known cardioprotective effects, including antioxidant and anti-inflammatory properties.
- Previous research links vitamin D deficiency to worse outcomes in coronary artery disease (CAD), particularly in ST-segment elevation myocardial infarction (STEMI) patients.
- Limited data exist on vitamin D levels' association with angiographic findings and reperfusion in STEMI patients treated with primary percutaneous coronary intervention (pPCI).
Purpose of the Study:
- To investigate the relationship between vitamin D levels and angiographic findings, specifically epicardial reperfusion.
- To assess the association between vitamin D status and procedural outcomes in STEMI patients undergoing pPCI.
Main Methods:
- A cohort of 450 STEMI patients treated with pPCI were analyzed.
- Serum 25(OH)D levels were measured upon admission; hypovitaminosis D was defined as <10 ng/ml.
- Patients were stratified into tertiles based on vitamin D levels, and associations with clinical, angiographic, and procedural data were examined.
Main Results:
- Lower vitamin D levels correlated with increased diuretic use, higher white blood cell counts and glycemia, fewer bifurcation lesions, and smaller target vessel diameter.
- While pre-procedural TIMI flow was similar, patients with lower vitamin D showed a significantly higher rate of impaired epicardial reperfusion (adjusted OR=2.6).
- Impaired reperfusion in lower vitamin D groups necessitated increased use of adenosine and glycoprotein IIb/IIIa inhibitors.
Conclusions:
- Low vitamin D levels are independently associated with impaired epicardial reperfusion in STEMI patients undergoing pPCI.
- Further research is warranted to explore the prognostic implications of hypovitaminosis D and potential therapeutic interventions in this patient population.
Background And Aims:
Vitamin D displays a broad spectrum of cardioprotective effects, preventing oxidative stress, inflammation and thrombosis and improving endothelial function. Previous studies have associated vitamin D deficiency with more extended and severe coronary artery disease (CAD) and worse outcome, and especially among patients with ST-segment elevation myocardial infarction (STEMI). However, few data have been reported on the association of vitamin D levels with the angiographic findings and epicardial reperfusion in STEMI patients undergoing primary percutaneous coronary intervention (pPCI), that was therefore the aim of the present study.
Methods And Results:
A consecutive cohort of patients admitted for STEMI and treated with pPCI were included. The levels of 25(OH)D were assessed at admission by chemiluminescence immunoassay kit LIAISON® Vitamin D assay (Diasorin Inc). Hypovitaminosis D was defined for 25(OH)D < 10 ng/ml. We included in our study 450 patients, divided according to tertiles values of 25(OH)D. Lower vitamin D was associated to a higher use of diuretics (p = 0.02), higher levels of white blood cells and glycemia (p < 0.001), lower prevalence of lesions on bifurcations (p = 0.03) and smaller diameter of the target coronary vessel (p = 0.03). Procedural characteristics and pre-procedural TIMI flow were not different according to vitamin D levels, but for a higher rate of impaired epicardial reperfusion (12.8% vs 8.1% vs 5.3%, p = 0.03, adjusted OR[95%CI] = 2.6[1.05-6.6], p = 0.04 for I vs III tertile), requiring higher use of adenosine (p = 0.006) and glycoprotein IIbIIIa inhibitors (p = 0.01).
Conclusion:
The present study shows that among patients with STEMI undergoing pPCI, lower levels of vitamin D are independently associated with impaired reperfusion, Future dedicated studies will shed light on the prognostic implications of hypovitaminosis D in these patients and the potential therapeutic perspectives.
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