title: Decreased TSP-1 following percutaneous coronary intervention is associated with major adverse cardiac events in ST-elevation myocardial infarction.
abstract: BACKGROUND
  TSP-1 is a vasoconstrictive protein, which is released from both endothelium and cardiomyocytes during ischemia and promotes platelet aggregation and adhesion to subendothelial layers in atherosclerotic lesions. During myocardial ischemia and reperfusion, TSP-1 disturbs local microcirculation by disrupting both NO-signaling as well as VEGF-pathways by activation of CD47 and CD36. Furthermore, activation of TGF-ß might induce excessive fibrosis after infarction. It was assumed that TSP-1 is washed out after successful coronary reperfusion. In this study, we examined circulating TSP-1 post emergency PCI as a risk factor for major adverse cardiac events after STEMI with and without ventricular fibrillation.
  
  
  METHODS
  TSP-1 levels in platelet poor plasma were measured in 54 patients after ST-elevation myocardial infarction. Major adverse cardiac events were monitored for 426 days.
  
  
  RESULTS
  Patients with decreased TSP levels after coronary stenting showed a significantly higher risk for MACE than patient with higher TSP levels (TSP-1[d0]: n = 46, no MACE = 16.38 ± 1.98 ug/mL vs. MACE 7.11 ± 1.54 ug/mL; p = 0.003). Kaplan-Meyer-analysis for MACE showed a better outcome above 10 ug/mL (p = 0.02). For MACE later than 3 months post-STEMI, the corresponding Kaplan-Meier-analysis yielded a p-value of 0.01. The number needed to diagnose for late MACE was 2.158.
  
  
  CONCLUSIONS
  Low plasma levels of TSP1 after PCI are associated with MACE. Due to its procoagulant effects and dysregulation of microvascular tone, adequately powered prospective studies are warranted to test the impact of TSP-1 on cardiac microcirculation, endothelial function and remodeling. TSP-1 might serve as a new diagnostic and therapeutic approach in cardiovascular disease.
authors: Department of Pulmonology, Saarland University, Homburg/Saar, Germany. ralfkaiser@gmx.net
authors: Ralf
authors: R
authors: Kaiser
authors: Katharina
authors: K
authors: Grotemeyer
authors: Thorsten
authors: T
authors: Kälsch
authors: Stefan
authors: S
authors: Gräber
authors: Heinrike
authors: H
authors: Wilkens
authors: Elif
authors: E
authors: Elmas
mesh_terms: D051778:Basic Helix-Loop-Helix Leucine Zipper Transcription Factors / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D003326:Coronary Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood*; D015425:Myocardial Reperfusion / Q000009:adverse effects / Q000379:methods; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000379:methods*; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D051778:Basic Helix-Loop-Helix Leucine Zipper Transcription Factors; D015415:Biomarkers; C481348:SPZ1 protein, human