Baseline von Willebrand factor plasma levels and no-reflow phenomenon after primary percutaneous coronary intervention for ST segment elevation myocardial infarction.
No-reflow phenomenon is associated with a poor prognosis and its underlying mechanisms are still poorly understood. von Willebrand Factor (vWF) is a central molecule in haemostasis which plays an important role in acute coronary syndromes. However its possible role in no-reflow has not been assessed prior to this study. Quantitative baseline vWF plasma antigen was measured by immunoturbidometric assay in 54 consecutive patients with a first ST segment elevation acute myocardial infarction, treated by primary percutaneous coronary intervention within 12 h of symptom onset. Definitions of no-reflow were (1) angiographic: final TIMI flow ≤2 or final TIMI flow 3 with a myocardial blush grade <2; (2) electrocardiographic: lack of ST segment resolution (≤50% reduction of ST segment elevation at 90 min). Angiographic and electrocardiographic no-reflow was observed in 32 (59%) and 30 (56%) patients, respectively (only 9 patients had both type of no-reflow). Plasma levels of vWF were significantly higher in patients with angiographic no-reflow but not in those with electrocardiographic no-reflow. Also, vWF was the most powerful independent predictors of angiographic no-reflow (OR 3.8, 95% CI 1.1-12.9, p=0.033). Our results provide new insights into no-reflow pathophysiology with appealing therapeutic implications.
Sgueglia
Gregory Angelo
GA
Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address: g.a.sgueglia@gmail.com.
Niccoli
Giampaolo
G
Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Rome, Italy.
Spaziani
Cristina
C
Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Rome, Italy.
Cosentino
Nicola
N
Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Rome, Italy.
Russo
Eleonora
E
Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Rome, Italy.
Andreotti
Felicita
F
Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Rome, Italy.
Lanza
Gaetano Antonio
GA
Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Rome, Italy.
Landolfi
Raffaele
R
Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy.
Crea
Filippo
F
Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Rome, Italy.
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000628:therapy; D054318:No-Reflow Phenomenon / Q000097:blood* / Q000209:etiology; D014841:von Willebrand Factor / Q000378:metabolism*
D015415:Biomarkers; D014841:von Willebrand Factor