Department of Cardiology, Mustafa Kemal University, Tayfur Ata Sokmen Medical School, Hatay, Turkey.
Am J Cardiol. 2013 Jul 15;112(2):187-93. doi: 10.1016/j.amjcard.2013.03.011. Epub 2013 Apr 18.
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.
虽然单核细胞趋化蛋白-1（MCP-1）水平在 ST 段抬高型心肌梗死患者中升高，但 MCP-1 在经皮冠状动脉介入治疗（pPCI）中的预后价值尚不清楚。本研究旨在探讨 MCP-1 水平与接受 pPCI 的 ST 段抬高型心肌梗死患者心肌灌注和预后的关系。根据入院时血清 MCP-1 水平将连续接受 pPCI 的患者（n=192）分为 3 组。评估了无再流、心肌梗死溶栓治疗血流分级、心肌灌注分级和 ST 段回落情况。评估了住院期间和 3 年临床随访期间的死亡率和主要不良心脏事件。ST 段回落失败与入院时较高的 MCP-1 水平相关。无再流（pPCI 后心肌梗死溶栓治疗血流≤2 或心肌梗死溶栓治疗血流 3 级且最终心肌灌注分级≤2 和 ST 段回落<30%）的风险随着入院 MCP-1 的升高而增加。3 年死亡率随着 MCP-1 水平的升高而增加（3 组的 3 年死亡率分别为 8%、22%和 28%，p<0.01）。多变量逻辑回归分析表明，入院时 MCP-1 水平是无再流患者 3 年死亡率的独立相关因素，可通过心肌灌注分级来检测。受试者工作特征分析确定了≥254pg/ml 的最佳切点，与 1 年死亡率相关的阴性预测值为 95%。结论：ST 段抬高型心肌梗死患者 pPCI 后入院时的血浆 MCP-1 水平与无再流的发生和 3 年死亡率独立相关。
