Affiliation:
1. Duke Clinical Research Institute Durham NC
2. Canadian VIGOUR Centre University of Alberta Edmonton Alberta Canada
3. Inova Heart and Vascular Institute Falls Church VA
Abstract
Background
Despite restoration of epicardial flow following primary percutaneous coronary intervention (
PPCI
), microvascular reperfusion as reflected by
ST
‐elevation resolution (
ST
‐
ER
) resolution remains variable and its pathophysiology remains unclear.
Methods and Results
Using principal component analyses, we explored associations between 91 serum biomarkers drawn before
PPCI
clustered into 14 pathobiologic processes (including
NT‐
pro
BNP
[N‐terminal pro‐B‐type natriuretic peptide] as an independent cluster), and (1)
ST
‐
ER
resolution ≥50% versus <50%; and (2) 90‐day composite of death, shock, and heart failure. Network analyses were performed to understand interbiomarker relationships between the
ST
‐
ER
groups. Among the 1160 patients studied, 861 (74%) had
ST
‐
ER
≥50% at a median 40 (interquartile range, 23–70) minutes following
PPCI
, yet both groups had comparable post‐
PPCI TIMI
(Thrombolysis in Myocardial Infarction) grade 3 flow (86.6% versus 82.9%;
P
=0.25).
ST
‐
ER
≥50% was associated with significantly lower pre‐
PPCI
concentrations of platelet activation cluster (particularly P‐selectin, von Willebrand factor, and platelet‐derived growth factor A) and
NT‐
pro
BNP
, including after risk adjustment. Across both
ST
‐
ER
groups, strong interbiomarker relationships were noted between pathways indicative of myocardial stretch, platelet activation, and inflammation, whereas with
ST
‐
ER
<50% correlations between iron homeostasis and inflammation were observed. Of all 14 biomarker clusters, only
NT
‐pro
BNP
was significantly associated with the 90‐day clinical composite.
Conclusions
Suboptimal
ST
‐
ER
is common despite achieving post‐
PPCI TIMI
grade 3 flow. The cluster of platelet activation proteins and
NT‐
pro
BNP
were strongly correlated with suboptimal
ST
‐
ER
and
NT‐
pro
BNP
was independently associated with 90‐day outcomes. This analysis provides insights into the pathophysiology of microvascular reperfusion in
ST
‐segment–elevation myocardial infarction and suggests novel pre‐
PPCI
risk targets potentially amenable to enhancing tissue‐level reperfusion following
PPCI
.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
4 articles.
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