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


Buyukkaya E., Poyraz F., Karakas M. F. , Kurt M., Akcay A. B. , AKPINAR I., ...Daha Fazla

AMERICAN JOURNAL OF CARDIOLOGY, cilt.112, ss.187-193, 2013 (SCI İndekslerine Giren Dergi) identifier identifier identifier

  • Cilt numarası: 112 Konu: 2
  • Basım Tarihi: 2013
  • Doi Numarası: 10.1016/j.amjcard.2013.03.011
  • Dergi Adı: AMERICAN JOURNAL OF CARDIOLOGY
  • Sayfa Sayıları: ss.187-193

Özet

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. Crown Copyright (C) 2013 Published by Elsevier Inc. All rights reserved.

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-re

 

flow, 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 followup

visit. Failure of ST resolution was associated with greater admissionMCP-1 levels. The risk

of no-re

 

flow (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 thatMCP-1 levels at admission are a signi

 

ficant independent correlate

of 3-year mortality in patients with no-re

 

flow as detected by myocardial blush grade.

A receiver operating characteristics analysis identi

 

fied 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 plasmaMCP-1 levels at admission are independently associated

with the development of no-re

 

flow and 3-year mortality in patients with ST-segment elevation

myocardial infarction undergoing pPCI.