Novel grading system for ischemia‒reperfusion injury manifestations in patients with acute ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention

Abstract

To establish a simple myocardial ischemia‒reperfusion injury (MIRI) manifestation grading system based on clinical manifestations and coronary angiography during primary percutaneous coronary intervention (PPCI). All STEMI patients treated with PPCI from June 2018 to November 2019 were included. According to the MIRI manifestation grade, patients were divided into four grades (I–IV). Laboratory and clinical indicators of the patients and the occurrence of major adverse cardiac events (MACEs) within one year of follow-up were analyzed. A total of 300 patients were included. The higher the MIRI manifestation grade, the lower was the high-density lipoprotein cholesterol (HDL-C); the higher were the C-reactive protein (CRP), lipoprotein(a) [LP(a)], and peak levels of high-sensitivity troponin T (hs-cTnT), creatine kinase (CK-MB), and N-terminal pro-B-type natriuretic peptide (NT-proBNP); and the higher were the proportions of right coronary artery (RCA) and multivessel lesions (P < 0.05). The left ventricular end-diastolic dimension (LVEDD) and E/e′ values of patients with higher grades were significantly increased, while the LVEF, left ventricular short-axis functional shortening (LVFS) and E/A values were significantly decreased (P < 0.05). The one-year cumulative incidence of major adverse cardiac events (MACEs) in patients with grade I–IV disease was 7.7% vs. 26.9% vs. 48.4% vs. 93.3%, respectively, P < 0.05. The higher the MIRI manifestation grade, the more obvious is the impact on diastolic and systolic function and the higher is the cumulative incidence of MACEs within one year, especially in patients with multivessel disease, low HDL-C, high CRP, high LP(a) levels, and the RCA as the infarction-related artery.

Soluble CD137: A Potential Prognostic Biomarker in Critically Ill Patients

“…For instance, in patients with acute coronary syndromes, serum sCD137 was positively linked with CRP [29]. Similarly, a positive correlation was observed in patients with acute ST-segment elevation myocardial infarction [30]. Contrarily, in our SIRS/sepsis cohort, sCD137 was negatively associated with serum CRP levels.…”

Predictors of in-hospital mortality after successful weaning of venoarterial extracorporeal membrane oxygenation in cardiogenic shock

“…In our cohort, 85.4% of non-survivors had CS of ischemic origin. Coronary hypoperfusion with myocardial ischemia could contribute to multi-organ failure, and degree of coronary hypoperfusion is highly influenced by factors such as severity of coronary artery disease, time to revascularization, and revascularization strategy (culprit-only revascularization or multi-vessel revascularization) 19 , 20 . Therefore, focusing on ischemic CS and identifying contributors to the myocardial ischemia may verify novel, modifiable risk factors that contributes to in-hospital mortality after successful weaning of ECMO.…”