Endothelin-1 release in acute myocardial infarction as a predictor of long-term prognosis and no-reflow assessed by contrast-enhanced magnetic resonance imaging.

Abstract

BACKGROUND:

No-reflow after primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) is associated with poor prognosis. Endothelin-1 (ET-1) is a potent endothelium-derived vasoconstrictor that might aggravate reperfusion injury. The aim of our study was to assess the relationship between systemic ET-1 levels and the occurrence of no-reflow as well as to evaluate the prognostic value of ET-1 in a high-risk STEMI population.

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.

• 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)
• Copyright: 2010 Mosby, Inc. All rights reserved.

Chemical References

• Endothelin-1

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