Abstract 4759: Endothelin-1: A Useful Prognostic Marker After Acute Myocardial Infarction
INTRODUCTION: High Endothelin-1 (E-1) levels have been linked to poor clinical outcomes after myocardial infarction (MI). Vasoconstriction of the coronary microcirculation seems to be the underlying mechanism. However, the relationship between E-1 levels and microvascular integrity in the setting of MI has not been analyzed.
OBJECTIVES To assess the effect of E-1 on microvascular integrity, necrosis volume, left ventricular ejection fraction (LVEF) and myocardial savage (M-sav) in evolving MI.
METHODS: We measured E-1 levels in a consecutive series of 127 patients (pts) presenting with a first MI. Blood samples for E-1 measurements were taken 6 to 24 hours after MI onset. MRI was performed within 1 week following presentation and microvascular obstruction (MO), necrosis volume and LVEF was assessed by ce-CMR. M-sav was definded as the % of angiographic area at risk by the BARI score that spared necrosis on the MRI.
RESULTS: Mean age was 60.9±11,8 years and 94(80%) were males. MI location was anterior in 47.2%. As shown in table⇓, high E-1 levels were associated to admission Killip ≥2, higher prePCI TIMI 0, worse postPCI MBG and higher mortality at 30 days. MO was documented in 48%. High E-1 values were also associated with MO and worse M-sav while no significant correlation was obtained with necrosis volume and LVEF. Compared to Troponin I/CKMB peak values, E-1 levels showed better correlation with MO, M-sav, Killip on admission, MBG postPCI and mortality at 30 days.
CONCLUSIONS: In humans, high E-1 levels after MI are closely associated with the presence of MO and worse M-sav. E-1 assessment renders prognostic information, independent from that provided by LVEF and necrosis volume