Endothelin-1 release in acute myocardial infarction as a predictor of long-term prognosis and no-reflow assessed by contrast-enhanced magnetic resonance imaging

Ingo Eitel*, Marek Nowak, Clemens Stehl, Volker Adams, Georg Fuernau, Lysann Hildebrand, Steffen Desch, Gerhard Schuler, Holger Thiele

*Korrespondierende/r Autor/-in für diese Arbeit
47 Zitate (Scopus)

Abstract

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 ≤2 or TIMI flow 3 with final myocardial bush grade ≤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 ≥ 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.

OriginalspracheEnglisch
ZeitschriftAmerican Heart Journal
Jahrgang159
Ausgabenummer5
Seiten (von - bis)882-890
Seitenumfang9
ISSN0002-8703
DOIs
PublikationsstatusVeröffentlicht - 01.05.2010

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  • Forschungsschwerpunkt: Gehirn, Hormone, Verhalten - Center for Brain, Behavior and Metabolism (CBBM)

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