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Novel Biomarkers, ST-Elevation Resolution, and Clinical Outcomes Following Primary Percutaneous Coronary Intervention.

新型生物标志物、 ST 段抬高分辨率和直接经皮冠状动脉介入治疗后的临床结局。

  • 影响因子:4.44
  • DOI:10.1161/JAHA.120.016033
  • 作者列表:"Shavadia JS","Granger CB","Alemayehu W","Westerhout CM","Povsic TJ","Van Diepen S","Defilippi C","Armstrong PW
  • 发表时间:2020-06-17
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-proBNP [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-proBNP, 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-proBNP 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-proBNP were strongly correlated with suboptimal ST-ER and NT-proBNP 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.

摘要

背景: 尽管直接经皮冠状动脉介入治疗 (PPCI) 后心外膜血流恢复,但 ST 段抬高分辨率 (ST-ER) 分辨率反映的微血管再灌注仍然存在差异,其病理生理学仍不清楚。使用主成分分析的方法和结果,我们探讨了 PPCI 前提取的 91 个血清生物标志物之间的相关性,聚集到 14 个病理生物学过程中 (包括 NT-proBNP [N 末端 b型利钠肽前体] 作为独立的簇)。(1) ST-ER 分辨率 ≥ 50% vs <50%; (2) 90 天死亡、休克、和心力衰竭。进行网络分析以了解 ST-ER 组之间的生物标志物间关系。在研究的 1160 例患者中,861 例 (74%) 在 PPCI 后中位 40 (四分位距,23-70) 分钟时 ST-ER ≥ 50%,然而,两组 PPCI 后 TIMI (心肌梗死溶栓) 3 级血流相当 (86.6% vs 82.9%; P = 0.25)。ST-ER ≥ 50% 与 PPCI 术前血小板活化簇浓度显著降低相关 (特别是 P-选择素、血管性血友病因子和血小板衍生生长因子 A) 和 NT-proBNP,包括风险调整后。在两个 ST-ER 组中,在指示心肌牵张、血小板活化和炎症的通路之间观察到强烈的生物标志物间关系,而 ST-ER <50% 时,观察到铁稳态与炎症之间的相关性。在所有 14 个生物标志物簇中,只有 NT-proBNP 与 90 天临床复合显著相关。结论尽管达到了 PPCI 后 TIMI 3 级血流,但次优的 ST-ER 是常见的。血小板活化蛋白和 NT-proBNP 簇与次优 ST-ER 强相关,NT-proBNP 与 90 天结局独立相关。该分析提供了对 ST 段抬高型心肌梗死微血管再灌注病理生理学的见解,并提出了可能适合增强 PPCI 术后组织水平再灌注的新型 PPCI 前风险靶点。

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