Clinical significance of acute-phase endothelin-1 in acute myocardial infarction patients treated with direct coronary angioplasty

Background The aim of the present study was to investigate the relationship between plasma concentrations of endothelin (ET)-1 and clinical outcome (including mortality) and left ventricular (LV) systolic function in acute myocardial infarction (AMI). Methods and Results The study group comprised 110 consecutive first-AMI patients who were successfully reperfused by primary coronary intervention. Plasma ET-I concentrations were evaluated 24h from onset and the patients were divided into 2 groups according to the median value, either a high group (H group: >= 2.90pg/ml plasma ET-1; n=55) or low group (L group: < 2.90pg/ml plasma ET-1; n=55). Major complications and LV systolic function were monitored in the 2 groups. Both highly sensitive C-reactive protein (hs-CRP) and brain natriuretic peptide (BNP) showed a significant positive correlation with ET-1 (BNP: r=048, p < 0.0001, hs-CRP: r=0.43, p < 0.001). Chronic stage left ventricular ejection fraction (LVEF) and left ventricular end-diastolic volume index (LVEDVI) were significantly poorer in the H group (LVEF: 51 +/- 15% vs 60 +/- 13%, p=0.003, LVEDVI: 74 +/- 19 ml/m(2) vs 66 +/- 14 ml/m(2), p < 0.05). There were significantly more major complications in the H group than in the L group (cardiogenic shock: 18% vs 5%, p=0.04; cardiac death: 13% vs 0%, p < 0.01). Conclusions In the setting of AMI, plasma ET-I concentrations maybe closely related to LV systolic dysfunction and poor patient outcome, including mortality.