Plasma levels of thromboxane A2 on admission are associated with no-reflow after primary percutaneous coronary intervention.
OBJECTIVE
Thromboxane A2 (TXA2) is a key mediator of platelet activation and aggregation, and an important mediator of platelet-induced coronary artery constriction. We sought to investigate whether baseline plasma levels of TXA2 are associated with coronary no-reflow after primary percutaneous coronary intervention (PPCI).


RESULTS
A total of 47 consecutive patients (age, 62.5 +/- 12.7; male sex, 76.6%) admitted to our hospital for a first ST-segment elevation myocardial infarction and undergoing PPCI within 12 h of onset of symptoms were enrolled. Admission TXA2 plasma levels were measured by enzyme-linked immunosorbent assay (ELISA). Angiographic no-reflow was defined as a final TIMI flow of <or=2 or final TIMI flow of 3 with a myocardial blush grade of <2, whereas ST-segment resolution from baseline value of <or=50% was used as ECG index of no-reflow. At multivariable analysis TXA2 plasma levels, endothelin-1 (ET-1) plasma levels, and left anterior descending coronary artery (LAD) as culprit vessel were significant predictors of angiographic no-reflow (P = 0.04), whereas TXA2 and ET-1 plasma levels were the only independent predictors of lack of ST-segment resolution (P = 0.013 and 0.04, respectively). Of note, TXA2 tertiles were independent predictors of both angiographic no-reflow and lack of ST-segment resolution (OR, 3.5; 95% CI, 1.1-11; P = 0.03 and OR, 3; 95% CI, 1.3-7; P = 0.01, respectively).


CONCLUSIONS
TXA2 is an independent indicator of no-reflow that occurs after PPCI. This observation may open new therapeutic opportunity in the setting of PPCI.
Niccoli
Giampaolo
G
Institute of Cardiology, Catholic University of the Sacred Heart, Largo F Vito 1, 00168 Rome, Italy. gniccoli73@hotmail.it
Giubilato
Simona
S
Russo
Eleonora
E
Spaziani
Cristina
C
Leo
Andrea
A
Porto
Italo
I
Leone
Antonio M
AM
Burzotta
Francesco
F
Riondino
Silvia
S
Pulcinelli
Fabio
F
Biasucci
Luigi M
LM
Crea
Filippo
F
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000187:drug effects; D004562:Electrocardiography; D019332:Endothelin-1 / Q000097:blood; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000628:therapy*; D054318:No-Reflow Phenomenon / Q000097:blood* / Q000209:etiology; D018570:Risk Assessment; D013928:Thromboxane A2 / Q000097:blood*; D016896:Treatment Outcome
D015415:Biomarkers; D019332:Endothelin-1; D013928:Thromboxane A2