Level of complement activity predicts cardiac dysfunction after acute myocardial infarction treated with primary percutaneous coronary intervention.
BACKGROUND
The positive effect of reperfusion after ST-elevation myocardial infarction (STEMI) can be reduced by ischemic/reperfusion (I/R) injury.Mannose-binding-lectin (MBL) and soluble C5b-9 (membrane-attack-complex) are involved in complement-driven cell lysis and may play a role in human myocardial I/R injury. We evaluated the potential association between MBL and sC5b-9 in plasma and subsequent cardiac dysfunction in patients with STEMI treated with primary percutaneous coronary intervention (pPCI).


METHODS
The study included 74 STEMI-patients with acute occlusion of the left anterior descending coronary artery who were successfully treated with pPCI. Cardiac dysfunction was defined as left ventricular ejection fraction LVEF < 35%.


RESULTS
Patients with subsequent LVEF < 35% had significantly higher median MBL and lower sC5b-9 compared to patients with LVEF > or = 35%. After adjustment of the multivariate logistic regression analysis, the odds for reduced LVEF was 5.5 (95% CI:1.5-19.3; p = 0.01) for patients with MBL > or = 800 mcg/L, and 5.0 (95% CI 1.4-18.4; p = 0.01) for patients with sC5b-9 < or = 160 mcg/L.


CONCLUSIONS
High plasma MBL and low plasma sC5b-9 are independently associated with increased risk of cardiac dysfunction in STEMI patients treated with pPCI, probably due to increased complement activity during the ischemic and reperfusion process. The predictive value of low peripheral plasma sC5b-9 may be explained by an accumulation and activation of sC5b-9 in the infarcted myocardium.
Haahr-Pedersen
Sune
S
Department of Cardiology P, Gentofte University Hospital, Niels Andersens Vej 65, Copenhagen, Denmark. sunped01@geh.regionh.dk
Bjerre
Mette
M
Flyvbjerg
Allan
A
Mogelvang
Rasmus
R
Dominquez
Helena
H
Hansen
Troels Krarup
TK
Galatius
Søren
S
Bech
Jan
J
Madsen
Jan Kyst
JK
Søgaard
Peter
P
Jensen
Jan Skov
JS
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D015938:Complement Membrane Attack Complex / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D037601:Mannose-Binding Lectin / Q000097:blood; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000628:therapy*; D011237:Predictive Value of Tests; D012044:Regression Analysis; D015427:Reperfusion Injury / Q000097:blood; D012189:Retrospective Studies; D012307:Risk Factors; D015398:Signal Transduction; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology* / Q000503:physiopathology
D015415:Biomarkers; D015938:Complement Membrane Attack Complex; D037601:Mannose-Binding Lectin