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. 2022 Jun 7;11(4):336-349.
doi: 10.1093/ehjacc/zuac020.

Effects of early myocardial reperfusion and perfusion on myocardial necrosis/dysfunction and inflammation in patients with ST-segment and non-ST-segment elevation acute coronary syndrome: results from the PLATelet inhibition and patients Outcomes (PLATO) trial

Gorav Batra  1   2 , Henrik Renlund  2 , Vijay Kunadian  3 , Stefan K James  1   2 , Robert F Storey  4 , P Gabriel Steg  5 , Hugo A Katus  6 , Robert A Harrington  7   8 , C Michael Gibson  9   10 , Andrzej Budaj, Agneta Siegbahn  2 , Lars Wallentin  1   2
Affiliations

Effects of early myocardial reperfusion and perfusion on myocardial necrosis/dysfunction and inflammation in patients with ST-segment and non-ST-segment elevation acute coronary syndrome: results from the PLATelet inhibition and patients Outcomes (PLATO) trial

Gorav Batra et al. Eur Heart J Acute Cardiovasc Care. .

Abstract

Aims: Restoration of myocardial blood flow and perfusion during percutaneous coronary intervention (PCI) measured using Thrombolysis in Myocardial Infarction (TIMI) flow grade (TFG) and perfusion grade (TMPG) is associated with improved outcomes in acute coronary syndrome (ACS). Associations between TFG/TMPG and changes in biomarkers reflecting myocardial damage/dysfunction and inflammation is unknown.

Methods and results: Among 2606 patients included, TFG was evaluated in 2198 and TMPG in 1874 with ST-segment elevation myocardial infarction (STEMI) or non-ST-segment ACS (NSTE-ACS). Biomarkers reflecting myocardial necrosis [troponin T (TnT)], myocardial dysfunction [N-terminal prohormone brain natriuretic peptide (NT-proBNP)], inflammation [interleukin-6 (IL-6) and C-reactive protein (CRP)], and oxidative stress/ageing/inflammation [growth differentiation factor-15 (GDF-15)] were measured at baseline, discharge, and 1- and 6-month post-randomization. Associations between TFG/TMPG and changes in biomarker levels were evaluated using the Mann-Whitney-Wilcoxon signed test. In total, 1423 (54.6%) patients had STEMI and 1183 (45.4%) NSTE-ACS. Complete reperfusion after PCI with TFG = 3 was achieved in 1110 (85.3%) with STEMI and in 793 (88.5%) with NSTE-ACS. Normal myocardial perfusion with TMPG = 3 was achieved in 475 (41.6%) with STEMI and in 396 (54.0%) with NSTE-ACS. Levels of TnT, NT-proBNP, IL-6, CRP, and GDF-15 were substantially lower at discharge in patients with complete vs. incomplete TFG and STEMI (P < 0.01). This pattern was not observed for patients with NSTE-ACS. Patients with normal vs. abnormal TMPG and NSTE-ACS had lower levels of NT-proBNP at discharge (P = 0.01).

Conclusions: Successful restoration of epicardial blood flow in STEMI was associated with less myocardial necrosis/dysfunction and inflammation. Attainment of normal myocardial perfusion was associated with less myocardial dysfunction in NSTE-ACS.

Keywords: Acute coronary syndrome; Biomarkers; Percutaneous coronary intervention; TIMI flow grade; TIMI myocardial perfusion grade.

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Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Dynamic changes in biomarker levels (median values with confidence interval) in patients with complete vs. incomplete Thrombolysis in Myocardial Infarction flow grade.
Figure 2
Figure 2
Dynamic change in biomarker levels (median values with confidence interval) in patients with normal vs. abnormal Thrombolysis in Myocardial Infarction myocardial perfusion grade.
See this image and copyright information in PMC

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