Changes in iron metabolism after primary PCI in patients with STEMI and ischemia-reperfusion injury

Within the present study, the aim was to investigate the dynamic changes in iron metabolism parameters in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) and to evaluate their association with the occurrence of ischemia-reperfusion injury (IRI). The present single-center, prospective observational study enrolled 68 patients with STEMI undergoing primary PCI from January to December 2024. Clinical characteristics, laboratory data and echocardiographic findings were collected. Patients were classified into IRI (n=30) and non-IRI (n=38) groups based on predefined IRI criteria. Venous blood samples were obtained pre- and post-PCI to measure ferritin, hepcidin, heme and heme oxygenase-1 (HO-1) levels. Statistical analyses were conducted to compare the changes in these iron metabolism indices between the two groups. Among the 68 enrolled patients, the incidence of IRI was 44.1%. Ferritin showed a significant increase post-PCI. The rise in ferritin and hepcidin was more pronounced in the IRI group compared with the non-IRI group. Although both IRI and non-IRI groups exhibited an upward trend in heme and HO-1 after PCI, the elevation in heme was higher in the IRI group in comparison with the HO-1. Differences in heme and HO-1 between IRI and non-IRI groups were not statistically significant. In conclusion, post-PCI rises in ferritin and hepcidin were more pronounced in patients with STEMI and IRI, while heme and HO-1 showed non-significant upward trends. These results indicated an association between altered iron/heme metabolism and IRI and therefore support further evaluation of ferritin/hepcidin as candidate biomarkers, pending validation in larger multicenter studies with multivariable adjustment.