Low plasma glutathione levels after reperfused acute myocardial infarction are associated with late cardiac events.
OBJECTIVE
To clarify whether an altered redox state persists in the subacute phase of myocardial infarction and if specific redox patterns are associated with later cardiac events.


METHODS
Ninety-seven patients [80 men, median 63 (interquartile range, 53, 69) years] with a first acute myocardial infarction, with (53%) or without ST segment elevation, treated with successful percutaneous interventions, were tested at 5-6 days after admission for plasma alpha-tocopherol, ascorbic acid, total and reduced homocysteine, cysteine, glutathione, cysteinylglycine and blood-reduced glutathione, all assessed by high-pressure liquid chromatography. Free malondialdehyde was evaluated by gas chromatography. A subgroup of 14 patients had adjunctive blood samples within 1 h and at 72 h after angioplasty. Blood samples from 44 patients matched for age, sex, and risk factors served as controls. Patients were followed up for median 15 (interquartile range, 9, 17) months for cardiac events.


RESULTS
All plasma-reduced aminothiols, vitamins and plasma total glutathione were significantly lower in myocardial infarction at 5-6 days than in controls. In the 14 myocardial infarction patients sampled repeatedly, plasma-reduced glutathione, cysteinylglycine, total glutathione, and alpha-tocopherol significantly decreased, whereas blood-reduced glutathione, total homocysteine, and cysteine significantly increased over time. During follow-up, 20 of 97 (21%) patients had adverse cardiac events. Multivariate analysis revealed that only plasma-reduced glutathione was independently associated with events (hazard ratio 0.42, 95% confidence interval 0.18-0.99, P=0.04).


CONCLUSIONS
Acute myocardial infarction patients have an altered redox state at 5-6 days after successful reperfusion with respect to controls. Low plasma levels of reduced glutathione at discharge are associated with cardiac events at follow-up.
De Chiara
Benedetta
B
CNR Clinical Physiology Institute, Cardiology Department, Niguarda Ca' Granda Hospital, and Monzino Cardiology Center IRCCS, Department of Preclinic Sciences LITA Vialba, University of Milan, Milan, Italy.
Mafrici
Antonio
A
Campolo
Jonica
J
Famoso
Gabriella
G
Sedda
Valentina
V
Parolini
Marina
M
Cighetti
Giuliana
G
Lualdi
Alessandro
A
Fiorentini
Cesare
C
Parodi
Oberdan
O
D000368:Aged; D015415:Biomarkers / Q000097:blood; D016001:Confidence Intervals; D017023:Coronary Angiography; D004151:Dipeptides / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005978:Glutathione / Q000097:blood*; D006801:Humans; D008163:Luminescent Measurements; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000000981:diagnostic imaging / Q000628:therapy; D015425:Myocardial Reperfusion; D010084:Oxidation-Reduction; D011379:Prognosis; D016016:Proportional Hazards Models; D013997:Time Factors; D020107:Troponin T / Q000097:blood; D024502:alpha-Tocopherol / Q000097:blood
D015415:Biomarkers; D004151:Dipeptides; D020107:Troponin T; C028505:cysteinylglycine; D005978:Glutathione; D024502:alpha-Tocopherol