title: Usefulness of monocyte chemoattractant protein-1 to predict no-reflow and three-year mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
abstract: Although monocyte chemoattractant protein-1 (MCP-1) levels are increased in patients with ST-segment elevation myocardial infarction, the prognostic value of MCP-1 in primary percutaneous coronary intervention (pPCI) is not clear. The goal of the present study was to investigate the association of MCP-1 levels with myocardial perfusion and prognosis in patients with ST-segment elevation myocardial infarction undergoing pPCI. Consecutive pPCI patients (n = 192) were assigned to tertiles according to their admission serum MCP-1 levels. Angiographic no-reflow, Thrombolysis In Myocardial Infarction flow grade, myocardial blush grade, and ST-segment resolution were assessed. Mortality and major adverse cardiac events were evaluated during hospitalization and at the 3-year clinical follow-up visit. Failure of ST resolution was associated with greater admission MCP-1 levels. The risk of no-reflow (Thrombolysis In Myocardial Infarction flow ≤2 or Thrombolysis In Myocardial Infarction flow 3 with final myocardial blush grade ≤2 after pPCI and ST resolution <30%) increased as the admission MCP-1 increased. The 3-year mortality increased as the MCP-1 level increased (8% vs 22% vs 28% for the 3 tertiles, p <0.01). Multivariate logistic regression analysis demonstrated that MCP-1 levels at admission are a significant independent correlate of 3-year mortality in patients with no-reflow as detected by myocardial blush grade. A receiver operating characteristics analysis identified an optimum cut point of ≥254 pg/ml, which was associated with a negative predictive value of 95% in association with 1-year mortality. In conclusion, the plasma MCP-1 levels at admission are independently associated with the development of no-reflow and 3-year mortality in patients with ST-segment elevation myocardial infarction undergoing pPCI.
authors.affiliation: Department of Cardiology, Mustafa Kemal University, Tayfur Ata Sokmen Medical School, Hatay, Turkey.
authors.forename: Eyup
authors.initials: E
authors.lastname: Buyukkaya
authors.forename: Fatih
authors.initials: F
authors.lastname: Poyraz
authors.forename: Mehmet F
authors.initials: MF
authors.lastname: Karakas
authors.forename: Mustafa
authors.initials: M
authors.lastname: Kurt
authors.forename: Adnan B
authors.initials: AB
authors.lastname: Akcay
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Akpinar
authors.forename: Sedat
authors.initials: S
authors.lastname: Motor
authors.forename: Osman
authors.initials: O
authors.lastname: Turak
authors.forename: Oktay H
authors.initials: OH
authors.lastname: Ozturk
authors.forename: Nihat
authors.initials: N
authors.lastname: Sen
authors.forename: Mahmut
authors.initials: M
authors.lastname: Akpek
authors.forename: Mehmet G
authors.initials: MG
authors.lastname: Kaya
authors.forename: C Michael
authors.initials: CM
authors.lastname: Gibson
mesh_terms: D018932:Chemokine CCL2 / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality* / Q000601:surgery*; D054318:No-Reflow Phenomenon / Q000097:blood* / Q000401:mortality*; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D011379:Prognosis; D013997:Time Factors
chemical_list: D018932:Chemokine CCL2