Søndergaard Frederik T, Beske Rasmus P, Frydland Martin, Møller Jacob Eifer, Helgestad Ole K L, Jensen Lisette Okkels, Holmvang Lene, Goetze Jens P, Engstrøm Thomas, Hassager Christian
Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej, Copenhagen 9 DK-2100, Denmark.
Department of Cardiology-B, Odense University Hospital, Odense, Denmark.
Eur Heart J Acute Cardiovasc Care. 2023 Jan 27;12(1):48-52. doi: 10.1093/ehjacc/zuac146.
The no-or-slow-reflow phenomenon after primary percutaneous coronary intervention is associated with more extensive myocardial injury in patients with ST-elevation myocardial infarction (STEMI). Soluble suppression of tumourigenicity 2 (sST2) is released in acute myocardial response to injury, and an increase in plasma level in the initial phase of STEMI is associated with increased mortality and risk of heart failure. We have therefore explored the association of pre-intervention plasma sST2 with the post-procedural no-or-slow-reflow phenomenon in patients with STEMI.
We included consecutive patients with verified STEMI from two tertiary heart centres. Blood samples were collected at admission before angiography. Post-procedural coronary flow was assessed according to thrombolysis in myocardial infarction (TIMI) classification for STEMI. Patients were divided into two groups: post-procedural TIMI 0-2 as no-or-slow reflow and TIMI 3 as normal reflow. The association between sST2 and TIMI flow was explored using multiple logistic regression. A total of 1607 patients with available TIMI flow classification were included in the analysis. Normal reflow was seen in 1520 (94.6%), while 87 (5.4%) had no-or-slow reflow. No-or-slow-reflow patients had higher all-cause 30-day mortality [10 (11%) vs. 65 (4.3%), P = 0.006]. Pre-procedural sST2 was higher in the no-or-slow-flow group [47 ng/mL, interquartile range (IQR, 33-83) vs. 39 ng/mL (IQR 29-55), P < 0.001] and was independently associated with post-procedural no-or-slow flow [two-fold sST2 increase: odds ratio 1.44 (1.15-1.78), P = 0.0012].
In patients with STEMI, the sST2 level at admission before coronary angiography is independently associated with the post-procedural no-or-slow-reflow phenomenon.
在接受直接经皮冠状动脉介入治疗的ST段抬高型心肌梗死（STEMI）患者中，无复流或慢血流现象与更广泛的心肌损伤相关。可溶性肿瘤抑制因子2（sST2）在急性心肌损伤反应中释放，STEMI初始阶段血浆水平升高与死亡率增加及心力衰竭风险相关。因此，我们探讨了STEMI患者介入治疗前血浆sST2与术后无复流或慢血流现象之间的关联。
我们纳入了来自两个三级心脏中心的连续确诊STEMI患者。在血管造影术前入院时采集血样。根据STEMI的心肌梗死溶栓（TIMI）分类评估术后冠状动脉血流。患者分为两组：术后TIMI 0 - 2为无复流或慢血流，TIMI 3为正常血流。使用多因素逻辑回归探讨sST2与TIMI血流之间的关联。共有1607例有可用TIMI血流分类的患者纳入分析。1520例（94.6%）出现正常血流，而87例（5.4%）出现无复流或慢血流。无复流或慢血流患者的30天全因死亡率更高[10例（11%）对65例（4.3%），P = 0.006]。无复流或慢血流组介入治疗前的sST2更高[47 ng/mL，四分位数间距（IQR，33 - 83）对39 ng/mL（IQR 29 - 55），P < 0.001]，且与术后无复流或慢血流独立相关[sST2升高两倍：比值比1.44（1.15 - 1.78），P = 0.0012]。
在STEMI患者中，冠状动脉造影术前入院时的sST2水平与术后无复流或慢血流现象独立相关。
