Total occlusion of the infarct-related coronary artery correlates with brachial artery flow-mediated dilation in patients with ST-elevation myocardial infarction.
BACKGROUND
Occlusion of the coronary artery is the main cause of ST-elevation myocardial infarction (STEMI). In some patients, it is followed by early spontaneous thrombolysis. In this study, we tried to determine whether spontaneous thrombolysis in the infarct-related artery (IRA) correlates with the state of the endothelium, which we assessed using the brachial artery flow-mediated dilation (FMD) test.


METHODS
52 patients with STEMI were included in the study. Based on the results of coronary angiography performed during the first three days of STEMI, the patients were divided into two groups: Group I (n=33), consisting of patients with remaining total occlusion of the IRA, and Group II (n=19), consisting of patients with spontaneous thrombolysis. We assessed the endothelial function, using the brachial artery FMD test.


RESULTS
In Group I, during the first three days of STEMI, brachial artery FMD results were significantly lower than those in Group II: 5.41+/- (3.23-7.41)% versus 10.81+/-(8.00-14.89)%, respectively; P=0.000036. After 7-14 days, this difference disappeared because of significant elevation of the FMD levels in the first group. Group I was characterized by higher levels of high sensitive C-reactive protein (CRP), cholesterol, and cholesterol-LDL and lower usage of angiotensin-converting enzyme (ACE) inhibitors before STEMI.


CONCLUSIONS
The data presented above reveal that spontaneous coronary thrombolysis in patients with acute STEMI is associated with a preserved endothelium-dependent vasodilator response in the brachial artery. It can depend on the levels of hs-CRP, of fasting glucose, and of ACE-inhibitors from previous treatment.
Vasilieva
Elena
E
Department of Cardiology, Moscow State University of Medicine and Dentistry, Moscow, Russia. helena_vasilieva@mail.ru
Urazovskaya
Irina
I
Skrypnik
Dmitriy
D
Shpektor
Alexander
A
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001916:Brachial Artery / Q000503:physiopathology*; D003326:Coronary Circulation / Q000187:drug effects; D054059:Coronary Occlusion / Q000188:drug therapy / Q000503:physiopathology*; D004562:Electrocardiography; D004730:Endothelium, Vascular / Q000187:drug effects / Q000503:physiopathology*; D005260:Female; D005342:Fibrinolysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology*; D011379:Prognosis; D014664:Vasodilation
D000806:Angiotensin-Converting Enzyme Inhibitors