TY - JOUR
T1 - Effect of hemorheological parameters on myocardial injury after primary or elective percutaneous coronary intervention
AU - Crea, Filippo
AU - Fracassi, Francesco
AU - Vetrugno, Vincenzo
AU - Niccoli, Giampaolo
AU - Panicale, Serena
AU - Caprari, Patrizia
PY - 2018
Y1 - 2018
N2 - Background Abnormal blood viscosity favors atherosclerosis owing to endothelial dysfunction and changes in shear stress. Its effect on coronary microvasculature during percutaneous coronary intervention (PCI) is still unknown. We aimed to investigate the role of hemorheological parameters in the incidence of microvascular obstruction (MVO) and the periprocedural necrosis after primary or elective PCI, and secondarily, we evaluated their prognostic significance. Materials and methods We enrolled 25 patients with ST-elevation myocardial infarction (STEMI), 30 patients with non-ST-elevation myocardial infarction (NSTEMI), and 30 patients with stable angina (SA) undergoing PCI. MVO in patients with STEMI and periprocedural necrosis in patients with NSTEMI and those with SA were assessed using angiographic/electrocardiographic and laboratory methods, respectively. Hemorheological profile included blood viscosity (η) at shear rates 200 s -1 and 1 s -1, the erythrocyte aggregation index (η 1 /η 200), and plasma viscosity. Major adverse cardiovascular events occurrence was evaluated at follow-up. Results Patients with STEMI experiencing angiographic MVO (28%) had higher η 200 (5.42±1.28 vs. 3.98±1.22 mPas; P=0.015). Similarly, patients with STEMI experiencing electrocardiographic MVO (56%) had higher η 200 (4.58±0.36 vs. 3.94±0.19 mPas; P<0.001). Among patients with SA and patients with NSTEMI, those experiencing periprocedural necrosis (23.3%) had higher η 200 (5.30±0.86 vs. 4.37±0.88 mPas; P=0.001), η 1 (19.52±9.62 vs. 13.29±7.65 mPas; P=0.015) and η 1 /η 200 values (3.64±1.50 vs. 2.72±0.92; P=0.007). These significant differences were maintained after adjustment for age, sex, and cardiovascular risk factors. At follow-up (30±6 months), 25 (29.4%) patients presented major adverse cardiovascular events, and they had higher η 200 (5.18±1.00 vs. 4.25±1.01 mPas; P<0.001). Conclusion In patients undergoing either urgent or elective PCI, hemorheological parameters might contribute to myocardial injury and, if furtherly confirmed, to an unfavorable outcome.
AB - Background Abnormal blood viscosity favors atherosclerosis owing to endothelial dysfunction and changes in shear stress. Its effect on coronary microvasculature during percutaneous coronary intervention (PCI) is still unknown. We aimed to investigate the role of hemorheological parameters in the incidence of microvascular obstruction (MVO) and the periprocedural necrosis after primary or elective PCI, and secondarily, we evaluated their prognostic significance. Materials and methods We enrolled 25 patients with ST-elevation myocardial infarction (STEMI), 30 patients with non-ST-elevation myocardial infarction (NSTEMI), and 30 patients with stable angina (SA) undergoing PCI. MVO in patients with STEMI and periprocedural necrosis in patients with NSTEMI and those with SA were assessed using angiographic/electrocardiographic and laboratory methods, respectively. Hemorheological profile included blood viscosity (η) at shear rates 200 s -1 and 1 s -1, the erythrocyte aggregation index (η 1 /η 200), and plasma viscosity. Major adverse cardiovascular events occurrence was evaluated at follow-up. Results Patients with STEMI experiencing angiographic MVO (28%) had higher η 200 (5.42±1.28 vs. 3.98±1.22 mPas; P=0.015). Similarly, patients with STEMI experiencing electrocardiographic MVO (56%) had higher η 200 (4.58±0.36 vs. 3.94±0.19 mPas; P<0.001). Among patients with SA and patients with NSTEMI, those experiencing periprocedural necrosis (23.3%) had higher η 200 (5.30±0.86 vs. 4.37±0.88 mPas; P=0.001), η 1 (19.52±9.62 vs. 13.29±7.65 mPas; P=0.015) and η 1 /η 200 values (3.64±1.50 vs. 2.72±0.92; P=0.007). These significant differences were maintained after adjustment for age, sex, and cardiovascular risk factors. At follow-up (30±6 months), 25 (29.4%) patients presented major adverse cardiovascular events, and they had higher η 200 (5.18±1.00 vs. 4.25±1.01 mPas; P<0.001). Conclusion In patients undergoing either urgent or elective PCI, hemorheological parameters might contribute to myocardial injury and, if furtherly confirmed, to an unfavorable outcome.
KW - Cardiology and Cardiovascular Medicine
KW - blood viscosity
KW - coronary angioplasty
KW - hemorheology
KW - microvascular obstruction
KW - periprocedural necrosis
KW - Cardiology and Cardiovascular Medicine
KW - blood viscosity
KW - coronary angioplasty
KW - hemorheology
KW - microvascular obstruction
KW - periprocedural necrosis
UR - http://hdl.handle.net/10807/129139
UR - http://journals.lww.com/coronary-artery/pages/default.aspx
U2 - 10.1097/MCA.0000000000000661
DO - 10.1097/MCA.0000000000000661
M3 - Article
VL - 29
SP - 638
EP - 646
JO - Coronary Artery Disease
JF - Coronary Artery Disease
SN - 0954-6928
ER -