Endothelin-1 release in acute myocardial infarction as a predictor of long-term prognosis and no-reflow assessed by contrast-enhanced magnetic resonance imaging.
BACKGROUND
No-reflow after primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) is associated with poor prognosis. Endothelin-1 (ET-1) is a potent endothelium-derived vasoconstrictor that might aggravate reperfusion injury. The aim of our study was to assess the relationship between systemic ET-1 levels and the occurrence of no-reflow as well as to evaluate the prognostic value of ET-1 in a high-risk STEMI population.


METHODS
We examined 128 consecutive patients undergoing primary PCI in acute STEMI <12 hours after symptom onset. Endothelin-1 was assessed before and immediately after primary PCI. Patients were categorized into 2 groups defined by the median ET-1 level on admission. No-reflow was assessed by 3 different methods after PCI: angiographic Thrombolysis in Myocardial Infarction (TIMI) flow and myocardial blush grade, electrocardiographic ST-resolution, and microvascular obstruction (MO) measured by cardiac magnetic resonance imaging (MRI). The primary clinical end points were mortality and major adverse cardiovascular events. Clinical follow-up was conducted after a median of 19 months.


RESULTS
Patients with angiographically (TIMI flow < or =2 or TIMI flow 3 with final myocardial bush grade < or =2 after PCI), electrocardiographically (ST-resolution <30%), and MRI- (presence of MO) detected no-reflow had significantly higher ET-1 levels on admission. At multivariable logistic regression analysis, ET-1 levels on admission were the only significant predictor of MRI-detected no-reflow (P = .03) together with left ventricular ejection fraction (P = .002). An elevated ET-1 level > or = the median on admission was a significant predictor of long-term mortality.


CONCLUSIONS
Endothelin-1 on admission is associated with no-reflow and increased long-term mortality in a high-risk STEMI population reperfused by primary PCI.
Eitel
Ingo
I
Department of Internal Medicine-Cardiology, University of Leipzig-Heart Center, Germany. ingoeitel@gmx.de
Nowak
Marek
M
Stehl
Clemens
C
Adams
Volker
V
Fuernau
Georg
G
Hildebrand
Lysann
L
Desch
Steffen
S
Schuler
Gerhard
G
Thiele
Holger
H
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D019332:Endothelin-1 / Q000097:blood / Q000378:metabolism*; D005260:Female; D006801:Humans; D007089:Image Enhancement; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000378:metabolism* / Q000401:mortality* / Q000628:therapy; D054318:No-Reflow Phenomenon / Q000097:blood / Q000175:diagnosis*; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve
D019332:Endothelin-1