Endothelin-1 and acute myocardial infarction:: a no-reflow mediator after successful percutaneous myocardial revascularization

Aims No-reflow after a primary percutaneous coronary intervention (PCI) is associated with a high incidence of left ventricular (W) failure and a poor prognosis. Endothelin-1 (ET-1) is a potent endothelium-derived vasoconstrictor peptide and an important modulator of neutrophil function. Elevated systemic ET-1 levels have recently been reported to predict a poor prognosis in patients with acute myocardial infarction (AMI) treated by primary PCI. We aimed to investigate the relationship between systemic ET-1 plasma levels and no-reflow in a group of AMI patients treated by primary PCI. Methods and results A group of 51 patients (age 59 +/- 9.9 years, 44 mates) with a first AMI, undergoing successful primary or rescue PCI, were included in the study. Angiographic no-reflow was defined as coronary TIMI flow grade <= 2 or TIMI flow 3 with a final myocardial blush grade <= 2. Blood samples were obtained from all patients on admission for ET-1 levels measurement. No reflow was observed in 31 patients (61%). Variables associated with no-reflow at univariate analysis included culprit lesion of the left anterior coronary descending artery (LAD) (67 vs. 29%, P = 0.006) and ET-1 plasma levels (3.95 +/- 0.7 vs. 3.3 +/- 0.8 pg/mL, P = 0.004). At multivariable logistic regression analysis, ET-1 was the only significant predictor of no-reflow (P = 0.03) together with LAD as the culprit vessel (P = 0.04). Conclusion ET-1 plasma levels predict angiographic no-reflow after successful primary or rescue PCI. These findings suggest that ET-1 antagonists might be beneficial in the management of no-reflow.