Abstract 15083: Early Spontaneous Vagal Reflexes Reduce the Inflammatory Response in Patients with Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention
BACKGROUND: Depressed vagal activity -assessed 4 weeks after myocardial infarction (MI) - is a independent predictor of cardiac mortality in patients with an ST elevation myocardial infarction (STEMI). Recently, the “cholinergic anti-inflammatory pathway” has been described: vagal activity can inhibit the release of pro-inflammatory cytokines (CK) such as interleukin-6 (IL6), without influencing the anti-inflammatory CK. IL6 exerts unfavorable effects and is involved in no-reflow pathophysiology, since it triggers neutrophil chemotaxis after myocardial ischemia-reperfusion (I/R). In fact, several studies have demonstrated that vagal stimulation can reduce inflammatory response, infarct size and no-reflow in animal models of myocardial I/R. The relationship between vagal activity and inflammatory response in STEMI has never been assessed.
AIM: We assessed the relationship between vagal activity and IL6 concentrations (IL6c) in patients during the first hours after a STEMI treated with primary percutaneous coronary intervention (PCI).
METHODS: We enrolled 29 patients with STEMI undergoing primary PCI. We evaluated vagal activity by calculating baroreflex sensitivity (BRS) with sequence method from spontaneous rate-pressure recordings 1 (BRS1h)-3 (BRS3h)-6-12 and 24 hours (h) after PCI. We determined IL6c with immunometric assay on serum samples collected before and 6-12-24-36h after PCI. IL6 and BRS values were log-normalized.
RESULTS: We found a significant negative correlation between BRS1h and IL6c 6h after PCI (R= -0.52, p=0.004). The correlation between BRS1h and IL6c progressively declined at12h (R= -0.481, p=0.008) and 24h (R= -0.424, p=0.022);it was lost at 36h after PCI. BRS3h showed a similar correlation with IL6c 6h after PCI (R= -0.478, p=0.009), but no significant correlation with IL6c 12h, 24h and 36h after PCI. BRS values calculated after the 3rd h showed no significant correlation with any of the IL6c. IL6c before PCI were not correlated with any of the BRS values.
CONCLUSIONS: Patients with higher BRS values after myocardial infarction/reperfusion showed lower levels of serum IL6. This study provides the first evidence suggesting an anti-inflammatory effect of vagal activity during myocardial infarction in man.
- Autonomic nervous system
- Myocardial infarction, STEMI
- Percutaneous coronary intervention (PCI)
- Reperfusion injury
Author Disclosures: A. Ravera: None. A. Lesce: None. R. Camporotondo: None. M. Ferrario: None. A. Repetto: None. A. Demarchi: None. R. Albertini: None. G.M. De Ferrari: None.
- © 2014 by American Heart Association, Inc.