Endothelin-1 and acute myocardial infarction: a no-reflow mediator after successful percutaneous myocardial revascularization.
OBJECTIVE
No-reflow after a primary percutaneous coronary intervention (PCI) is associated with a high incidence of left ventricular (LV) failure and a poor prognosis. Endothelin-1 (ET-1) is a potent endothelium-derived vasoconstrictor peptide and an important modulator of neutrophil function. Elevated systemic ET-1 levels have recently been reported to predict a poor prognosis in patients with acute myocardial infarction (AMI) treated by primary PCI. We aimed to investigate the relationship between systemic ET-1 plasma levels and no-reflow in a group of AMI patients treated by primary PCI.


RESULTS
A group of 51 patients (age 59+/-9.9 years, 44 males) with a first AMI, undergoing successful primary or rescue PCI, were included in the study. Angiographic no-reflow was defined as coronary TIMI flow grade < or =2 or TIMI flow 3 with a final myocardial blush grade < or =2. Blood samples were obtained from all patients on admission for ET-1 levels measurement. No reflow was observed in 31 patients (61%). Variables associated with no-reflow at univariate analysis included culprit lesion of the left anterior coronary descending artery (LAD) (67 vs. 29%, P=0.006) and ET-1 plasma levels (3.95+/-0.7 vs. 3.3+/-0.8 pg/mL, P=0.004). At multivariable logistic regression analysis, ET-1 was the only significant predictor of no-reflow (P=0.03) together with LAD as the culprit vessel (P=0.04).


CONCLUSIONS
ET-1 plasma levels predict angiographic no-reflow after successful primary or rescue PCI. These findings suggest that ET-1 antagonists might be beneficial in the management of no-reflow.
Niccoli
Giampaolo
G
Institute of Cardiology, Catholic University of the Sacred Heart, 00168 Rome, Italy. gniccoli73@hotmail.it
Lanza
Gaetano Antonio
GA
Shaw
Sidney
S
Romagnoli
Enrico
E
Gioia
Domenico
D
Burzotta
Francesco
F
Trani
Carlo
C
Mazzari
Mario A
MA
Mongiardo
Rocco
R
De Vita
Maria
M
Rebuzzi
Antonio G
AG
Lüscher
Thomas F
TF
Crea
Filippo
F
D015906:Angioplasty, Balloon, Coronary; D003326:Coronary Circulation / Q000502:physiology; D019332:Endothelin-1 / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000628:therapy; D009204:Myocardial Revascularization / Q000379:methods*; D011379:Prognosis; D012044:Regression Analysis
D019332:Endothelin-1