title: Patients with microvascular obstruction after primary percutaneous coronary intervention show a gp91phox (NOX2) mediated persistent oxidative stress after reperfusion.
abstract: BACKGROUND
  Persistent oxidative stress may play a key role in microvascular obstruction (MVO). We aimed at assessing the role of platelet gp91phox (NOX2), the catalytic subunit of NADPH oxidase in MVO.
  
  
  METHODS
  We enrolled 40 patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention within 12 h from symptoms onset, either with angiographic MVO (n=20) or good angiographic myocardial reperfusion (MR) (n=20). Angiographic MVO was defined as a final thrombolysis in myocardial infarction (TIMI) flow ≤2 or TIMI flow of 3 with myocardial blush grade <2. NOX2 and isoprostanes (8-iso-PGF2α) levels, as assessed by enzyme-linked immunoadsorbent assay (ELISA) or by an enzyme immunoassays, respectively, were measured on admission, at 24 h and pre-discharge.
  
  
  RESULTS
  NOX2 levels increased from baseline to pre-discharge in patients with angiographic MVO (20.25 (15-24.75) pg/ml vs 25.50 (17-29.25) pg/ml, p=0.02), but not in MR patients (p=0.45), with a significant interaction between baseline and pre-discharge levels among the two groups (p=0.04). The levels of 8-iso-PGF2α showed a trend to increase from baseline to pre-discharge in angiographic MVO patients (295 (183.50-389.25) pmol/l vs 322 (206-370) pmol/l, p=0.06), but not in patients with MR (p=0.56), with a trend for interaction between baseline and pre-discharge levels among the two groups (p=0.09).
  
  
  CONCLUSIONS
  Patients with MVO, but not those with myocardial reperfusion, have a sustained increase of NOX2 and 8-iso-PGF2α. Therapies targeting NOX2 or high dosage antioxidants should be tested for MVO prevention and treatment.
authors: Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
authors: Giampaolo
authors: G
authors: Niccoli
authors: Andrea
authors: A
authors: Celestini
authors: Camilla
authors: C
authors: Calvieri
authors: Nicola
authors: N
authors: Cosentino
authors: Elena
authors: E
authors: Falcioni
authors: Roberto
authors: R
authors: Carnevale
authors: Cristina
authors: C
authors: Nocella
authors: Francesco
authors: F
authors: Fracassi
authors: Marco
authors: M
authors: Roberto
authors: Roberta P
authors: RP
authors: Antonazzo
authors: Pasquale
authors: P
authors: Pignatelli
authors: Filippo
authors: F
authors: Crea
authors: Francesco
authors: F
authors: Violi
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D003326:Coronary Circulation; D023903:Coronary Restenosis / Q000097:blood* / Q000000981:diagnostic imaging / Q000209:etiology; D004562:Electrocardiography; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D008297:Male; D008562:Membrane Glycoproteins / Q000097:blood*; D008833:Microcirculation; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D000074662:NADPH Oxidase 2; D019255:NADPH Oxidases / Q000097:blood*; D018384:Oxidative Stress; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D008562:Membrane Glycoproteins; C056558:CYBB protein, human; D000074662:NADPH Oxidase 2; D019255:NADPH Oxidases
keywords: ST-elevation myocardial infarction; microvascular obstruction; oxidative stress; primary percutaneous coronary intervention