Clinical & Experimental Cardiology
Open Access
ISSN: 2155-9880
ISSN: 2155-9880
Makoto Suzuki
Accepted Abstracts: J Clin Exp Cardiolog
We characterized the degree of systemic and coronary inflammation and the impact of those on clinical state in patients with a cardiogenic shock complicating first anterior ST-segment elevation myocardial infarction (STEMI). Methods: We recruited 14 consecutive patients with cardiogenic shock (10 men, 69 � 12 years) and 18 well-matched baseline characteristics with- out shock (17 men, 64 � 9 years) undergoing per- cutaneous coronary intervention (PCI) for an early phase of a first anterior STEMI in whom plasma level of cardiac enzyme was less elevated. We measured systemic and coronary levels of C-reactive protein, interleukin-6, and angiotensin II, and evaluated the relation of those to myocardial tissue-level reperfusion using both angiographic myocardial blush grade from 0 to 3, with the highest grade indicating normal myocardial perfusion, and a resolution of the sum of ST-segment elevation in 12-lead electrocardiogram. Results: In-hospital mortality was 57% in patients with cardiogenic shock and 6% without shock (p = 0.005). Coronary levels of C-reactive protein (9.2 � 6.9 vs. 1.7 � 2.1 mg/L, p = 0.001), interleukin-6 (379 � 137 vs. 24 � 20 pg/mL, p = 0.003), and angiotensin II (19 � 10 vs. 10 � 6 pg/mL, p = 0.010) were extremely higher in patients with shock than without shock. Inter- leukin-6 and angiotensin II, but not C-reactive protein, revealed higher in coronary levels than in systemic levels. The presence of both myocardial blush grade < 3 and ST-segment resolution< 50%, indicating failed myocardial tissue- level reperfusion, was found in 8 patients withshock and 3 without shock (57% vs. 17%, p = 0.026). A multivariate regression analysis show- ed culprit coronary levels of angiotensin II as a special association with failed myocardial tis- sue-level reperfusion (p = 0.012). Conclusions: The exaggerated systemic and coronary inflammation, presumably associated with myocardial mal-reperfusion, was presented in patients with a cardiogenic shock complicating first anterior STEMI