Abstract | BACKGROUND: METHODS: We examined 128 consecutive patients undergoing primary PCI in acute STEMI <12 hours after symptom onset. Endothelin-1 was assessed before and immediately after primary PCI. Patients were categorized into 2 groups defined by the median ET-1 level on admission. No-reflow was assessed by 3 different methods after PCI: angiographic Thrombolysis in Myocardial Infarction (TIMI) flow and myocardial blush grade, electrocardiographic ST-resolution, and microvascular obstruction (MO) measured by cardiac magnetic resonance imaging (MRI). The primary clinical end points were mortality and major adverse cardiovascular events. Clinical follow-up was conducted after a median of 19 months. RESULTS: Patients with angiographically (TIMI flow < or =2 or TIMI flow 3 with final myocardial bush grade < or =2 after PCI), electrocardiographically (ST-resolution <30%), and MRI- (presence of MO) detected no-reflow had significantly higher ET-1 levels on admission. At multivariable logistic regression analysis, ET-1 levels on admission were the only significant predictor of MRI-detected no-reflow (P = .03) together with left ventricular ejection fraction (P = .002). An elevated ET-1 level > or = the median on admission was a significant predictor of long-term mortality. CONCLUSIONS:
Endothelin-1 on admission is associated with no-reflow and increased long-term mortality in a high-risk STEMI population reperfused by primary PCI.
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Authors | Ingo Eitel, Marek Nowak, Clemens Stehl, Volker Adams, Georg Fuernau, Lysann Hildebrand, Steffen Desch, Gerhard Schuler, Holger Thiele |
Journal | American heart journal
(Am Heart J)
Vol. 159
Issue 5
Pg. 882-90
(May 2010)
ISSN: 1097-6744 [Electronic] United States |
PMID | 20435200
(Publication Type: Journal Article)
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Copyright | 2010 Mosby, Inc. All rights reserved. |
Chemical References |
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Topics |
- Aged
- Angioplasty, Balloon, Coronary
- Coronary Angiography
- Endothelin-1
(blood, metabolism)
- Female
- Humans
- Image Enhancement
- Kaplan-Meier Estimate
- Magnetic Resonance Imaging
(methods)
- Male
- Middle Aged
- Myocardial Infarction
(metabolism, mortality, therapy)
- No-Reflow Phenomenon
(blood, diagnosis)
- Prognosis
- Prospective Studies
- ROC Curve
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