title: Elevated plasma asymmetric dimethylarginine level in acute myocardial infarction patients as a predictor of poor prognosis and angiographic impaired reperfusion.
abstract: OBJECTIVE
  We aimed to investigate the effects of admission asymmetric dimethylarginine (ADMA) levels on myocardial perfusion and prognosis in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  ADMA, an endogenous inhibitor of endothelial nitric oxide synthase, was found to be elevated in plasma of patients with cardiovascular risk factors.
  
  
  METHODS
  168 consecutive patients undergoing primary PCI for STEMI <12 h after symptom onset and 75 healthy age and sex matched volunteer controls were enrolled in the study. Patients with STEMI were grouped into tertiles according to their admission plasma ADMA levels. Major adverse cardiac events during hospitalization or at one-year clinical follow-up were evaluated. Also angiographic impaired reperfusion was assessed by 3 different methods after PCI: angiographic thrombolysis in myocardial infarction (TIMI) flow, TIMI frame count and TIMI myocardial perfusion grade (TMPG).
  
  
  RESULTS
  Plasma level of L-arginine were lower in patients with STEMI than in the control group subjects, whereas plasma ADMA levels were increased in the STEMI patient group. The rate of impaired angiographic reperfusion increased across the tertile groups. Also one-year mortality rates showed a significant increase across the tertile groups (4% vs. 10% vs. 20%, p<0.01). Using multiple Cox regression analysis, only TIMI risk score, left ventricle ejection fraction (LVEF), abnormal TMPG, and increased ADMA values on admission emerged as independent predictors of one-year mortality. The ROC analysis indicated an optimal cut-point of ≥1.37 μmol/L, which detects one-year mortality with a negative predictive value of 96%.
  
  
  CONCLUSIONS
  In STEMI patients undergoing primary PCI, high admission ADMA levels were found to be associated with impaired myocardial perfusion and increased one-year mortality. Therefore admission ADMA level detection may be helpful in identifying the patients at a greater risk of impaired myocardial perfusion and poor prognosis.
authors: Department of Cardiology, Mustafa Kemal University, Tayfur Ata Sokmen Medical School, Hatay, Turkey.
authors: Nihat
authors: N
authors: Sen
authors: Mehmet Fatih
authors: MF
authors: Ozlu
authors: Emin Ozgur
authors: EO
authors: Akgul
authors: Selcuk
authors: S
authors: Kanat
authors: Tuncer
authors: T
authors: Cayci
authors: Osman
authors: O
authors: Turak
authors: Halil
authors: H
authors: Yaman
authors: Erdogan
authors: E
authors: Sokmen
authors: Firat
authors: F
authors: Ozcan
authors: Orhan
authors: O
authors: Maden
authors: Ahmet Duran
authors: AD
authors: Demir
authors: Adrian
authors: A
authors: Covic
authors: Mehmet
authors: M
authors: Kanbay
mesh_terms: D000368:Aged; D001120:Arginine / Q000031:analogs & derivatives* / Q000097:blood; D017023:Coronary Angiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality*; D015425:Myocardial Reperfusion / Q000009:adverse effects*; D011379:Prognosis
chemical_list: C018524:N,N-dimethylarginine; D001120:Arginine