Abstract 18658: Vagal Activity Reduces C-Reactive Protein in Patients With Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention
Introduction: Inflammation is the underlying mechanism of reperfusion injury that may increase infarct size. Several studies have shown that vagal stimulation can reduce the inflammatory response associated with acute myocardial ischemia, the no-reflow phenomenon and infarct size in animal models. Whether this anti-inflammatory pathway is present in humans and may be active during an ST elevation myocardial infarction (STEMI) is presently unknown.
Hypothesis: Measures of spontaneous vagal activity have a negative correlation with high sensitivity (hs) C-reactive protein (CRP) peak concentration during the first hours after a STEMI treated with primary percutaneous coronary intervention (pPCI).
Methods: We enrolled 45 patients (pts) with STEMI undergoing primary PCI, and we assessed spontaneous vagal activity by calculating baroreflex sensitivity (BRS) with the sequence method from rate-pressure recordings obtained 1, 3, 6, 12 and 24 hours (h) after PCI. We determined hsCRP on serum samples collected before and 6-12-24-36h after PCI and then we considered the peak value for each patient. Both BRS and hsCRP values were log-normalized for most statistical tests.
Results: The mean age of the 45 pts enrolled was 63±14 years, 38 were male, 20 had anterior MI. The median BRS values at 1-3-6-12 and 24 h were 13.1, 13.6; 12.6, 12.3; 12.5 msec/mmHg respectively. The median peak hsCRP value was 0.85 mg/dl. Patients with BRS1h above the median showed lower hsCRP peak: 0.52 mg/dl (IQR=0.38-0.88) vs 1.61 mg/dl (0.63-4.91), p=0.003 by Mann Whitney test. We also found a significant negative correlation between BRS1h and hsCRP peak (R=-0.51, p=0.0003). There was a weaker but still significant correlation between BRS3h and hsCRP peak (R=-0.35, p=0.02). BRS values calculated after the 3rd h showed no significant correlation with hsCRP peak concentration.
Conclusions: Among patients with STEMI, higher spontaneous vagal activity in the very first hours following reperfusion was significantly associated with lower of hsCRP peak. This study provides evidence suggesting an anti-inflammatory effect of vagal activity during myocardial infarction in man and paves the way for future studies aiming to reduce reperfusion damage by increasing vagal activity at the time of pPCI.
Author Disclosures: A. Demarchi: None. A. Ravera: None. R. Camporotondo: None. D. Rizzotti: None. R. Albertini: None. V.M. Pirruccello: None. S. De Servi: None. G.M. De Ferrari: None.
- © 2016 by American Heart Association, Inc.