Novel grading system for ischemia‒reperfusion injury manifestations in patients with acute ST-segment elevation
Xiaotong Wang1, Binbin Li2, Yue Hu3
1Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai West Road, Xuzhou, 221004, Jiangsu, China.
Insights
A new grading system for myocardial ischemia-reperfusion injury (MIRI) effectively predicts patient outcomes. Higher MIRI grades correlate with worse cardiac function and increased major adverse cardiac events (MACEs) within one year.
Area of Science:
- Cardiology
- Clinical Medicine
- Biomarkers
Background:
- Myocardial ischemia-reperfusion injury (MIRI) is a critical complication following reperfusion therapy for ST-elevation myocardial infarction (STEMI).
- Accurate assessment of MIRI severity is crucial for predicting patient prognosis and guiding clinical management.
- Existing grading systems may not fully capture the clinical spectrum and prognostic implications of MIRI.
Purpose of the Study:
- To develop and validate a simple grading system for MIRI based on clinical and angiographic findings during primary percutaneous coronary intervention (PPCI).
- To evaluate the correlation between MIRI grades and clinical indicators, cardiac function, and major adverse cardiac events (MACEs).
Main Methods:
- A cohort of 300 STEMI patients undergoing PPCI were retrospectively analyzed.
- Patients were classified into four MIRI manifestation grades (I-IV) based on clinical and coronary angiography data.
- Laboratory markers (HDL-C, CRP, LP(a), hs-cTnT, CK-MB, NT-proBNP), echocardiographic parameters (LVEDD, E/e', LVEF, LVFS, E/A), and one-year MACE incidence were assessed.
Main Results:
- Higher MIRI grades were associated with lower HDL-C and increased CRP, LP(a), hs-cTnT, CK-MB, and NT-proBNP levels.
- Increased MIRI grades correlated with impaired left ventricular systolic (reduced LVEF, LVFS) and diastolic function (increased LVEDD, E/e').
- One-year MACE cumulative incidence significantly increased with MIRI grade (7.7% for Grade I vs. 93.3% for Grade IV).
Conclusions:
- The developed MIRI grading system effectively reflects the severity of myocardial injury and its impact on cardiac function.
- This grading system demonstrates strong prognostic value, predicting one-year MACE risk, particularly in patients with multivessel disease and specific biomarker profiles.
- The MIRI grading system provides a valuable tool for risk stratification and clinical decision-making in STEMI patients treated with PPCI.
Abstract:
To establish a simple myocardial ischemia‒reperfusion injury (MIRI) manifestation grading system based on clinical manifestations and coronary angiography during primary percutaneous coronary intervention (PPCI). All STEMI patients treated with PPCI from June 2018 to November 2019 were included. According to the MIRI manifestation grade, patients were divided into four grades (I-IV). Laboratory and clinical indicators of the patients and the occurrence of major adverse cardiac events (MACEs) within one year of follow-up were analyzed. A total of 300 patients were included. The higher the MIRI manifestation grade, the lower was the high-density lipoprotein cholesterol (HDL-C); the higher were the C-reactive protein (CRP), lipoprotein(a) [LP(a)], and peak levels of high-sensitivity troponin T (hs-cTnT), creatine kinase (CK-MB), and N-terminal pro-B-type natriuretic peptide (NT-proBNP); and the higher were the proportions of right coronary artery (RCA) and multivessel lesions (P < 0.05). The left ventricular end-diastolic dimension (LVEDD) and E/e' values of patients with higher grades were significantly increased, while the LVEF, left ventricular short-axis functional shortening (LVFS) and E/A values were significantly decreased (P < 0.05). The one-year cumulative incidence of major adverse cardiac events (MACEs) in patients with grade I-IV disease was 7.7% vs. 26.9% vs. 48.4% vs. 93.3%, respectively, P < 0.05. The higher the MIRI manifestation grade, the more obvious is the impact on diastolic and systolic function and the higher is the cumulative incidence of MACEs within one year, especially in patients with multivessel disease, low HDL-C, high CRP, high LP(a) levels, and the RCA as the infarction-related artery.
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