Abstract
Background: No‐reflow phenomenon is observed in approximately one‐third of patients after percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI), and is associated with poor functional and clinical outcomes. On the other hand, the formation of free radicals in vasculature exerts deleterious effects on coronary microcirculation.
Hypothesis: We hypothesized that redox state in coronary circulation may play a crucial role in no‐reflow phenomenon in AMI.
Methods: Consecutive 26 patients with first AMI who underwent primary PCI<24 h after onset were enrolled. Before PCI, blood samples were obtained from coronary sinus to measure plasma or serum antioxidative vitamins (vitamin C, vitamin E, and beta‐carotene) and antioxidative enzymes (extracellular glutathione peroxidase [GPX], superoxide dismutase, and catalase). After PCI, the corrected Thrombolysis In Myocardial Infarction (TIMI) frame count (CTFC) was measured in the target vessel. Patients with TIMI ≤2 flow despite an optimal PCI result were designated as no‐reflow group (Group NR, n = 6) and the others as reflow group (Group R,n = 20).
Results: Levels of vitamin C, vitamin E, and GPX before PCI were significantly lower in Group NR than in Group R. The CTFC correlated inversely with levels of vitamin C, vitamin E, and GPX (p < 0.05).
Conclusions: Depletion of antioxidants is associated with no‐reflow phenomenon in AMI. These findings strongly suggest that the redox state in coronary circulation plays an important role in the pathogenesis of no‐reflow phenomenon.
Keywords: oxidative stress, reperfusion, percutaneous coronary intervention, coronary circulation
Full Text
The Full Text of this article is available as a PDF (52.5 KB).
References
- 1. Ito H, Maruyama A, Iwakura K, Takiuchi S, Masuyama T, Hori M, Higashino Y, Fujii K, Minamino T: Clinical implications of “no‐reflow” phenomenon: A predictor of complications and left ventricular remodeling in reperfused anterior wall myocardial infarction. Circulation 1996; 93: 223–228 [DOI] [PubMed] [Google Scholar]
- 2. Garlick PB, Davies MJ, Hearse DJ, Slater TF: Direct detection of free radicals in the reperfused rat heart using electron spin resonance spectroscopy. Circ Res 1987; 61: 757–760 [DOI] [PubMed] [Google Scholar]
- 3. The TIMI Study Group : The Thrombolysis In Myocardial Infarction (TIMI) trial. N Engl J Med 1985; 31: 932–936 [DOI] [PubMed] [Google Scholar]
- 4. Gibson CM, Cannon CP, Daley WL, Dodge JT Jr, Alexander B Jr, Marble SJ, McCabe CH, Raymond L, Fortin T, Poole WK, Braunwald E: TIMI frame count: A quantitative method of assessing coronary artery flow. Circulation 1996; 93: 879–888 [DOI] [PubMed] [Google Scholar]
- 5. Reffelmann T, Kloner RA: No‐reflow phenomenon. Circulation 2002; 105: 656–662 [DOI] [PubMed] [Google Scholar]
- 6. Ferrari R, Ceconi C, Curello S, Guarnieri C, Caldarera CM, Albertini A, Visioli O: Oxygen‐mediated myocardial damage during ischemia and reperfusion: Role of the cellular defenses against oxygen toxicity. J Moll Cell Cardiol 1985; 17: 935–945 [DOI] [PubMed] [Google Scholar]
- 7. Pandey NR, Kaur G, Chandra M, Sanwal GG, Misra MK: Enzymatic oxidant and antioxidants of human blood platelets in unstable angina and myocardial infarction. Int J Cardiol 2000; 76: 33–38 [DOI] [PubMed] [Google Scholar]
- 8. Yoshida T, Maulik N, Engelman RM, Ho YS, Magnenat JL, Rousou JA, Flack JE III, Deaton D, Das DK: Glutathione peroxidase knockout mice are susceptible to myocardial ischemia reperfusion injury. Circulation 1997; 96 (suppl II): 216–220 [PubMed] [Google Scholar]
- 9. Yoshida T, Watanabe M, Engelman DT, Engelman RM, Schley JA, Maulik N, Ho YS, Oberley TD, Das DK: Transgenic mice overexpressing glutathione peroxidase are resistant to myocardial ischemia reperfusion injury. J Moll Cell Cardiol 1996; 28: 1759–1767 [DOI] [PubMed] [Google Scholar]
- 10. Sebbag L, Forrat R, Canet E, Renaud S, Delaye J, de Lorgeril M: Effects of dietary supplementation with alpha‐tocopherol on myocardial infarct size and ventricular arrhythmias in a dog model of ischemia‐reperfusion. J Am Coll Cadiol 1994; 24: 1580–1585 [DOI] [PubMed] [Google Scholar]
- 11. Campo GM, Squadrito F, Campo S, Altavilla D, Quartarone C, Ceccarelli S, Ferlito M, Avenoso A, Squadrito G, Saitta A, Caputi AP: Beneficial effect of raxofelast, a hydrophilic vitamin E analogue, in the rat heart after ischemia and reperfusion injury. J Moll Cell Cardiol 1998; 30: 1493–1503 [DOI] [PubMed] [Google Scholar]
- 12. Carrasquedo F, Glanc M, Fraga CG: Tissue damage in acute myocardial infarction: Selective protection by vitamin E. Free Radic Biol Med 1999; 26: 1587–1590 [DOI] [PubMed] [Google Scholar]
- 13. Morishima I, Sone T, Mokuno S, Taga S, Shimauchi A, Oki Y, Kondo J, Tsuboi H, Sassa H: Clinical significance of no‐reflow phenomenon observed on angiography after successful treatment of acute myocardial infarction with percutaneous trans luminal angioplasty. Am Heart J 1995; 130: 239–243 [DOI] [PubMed] [Google Scholar]
- 14. Iwakura K, Ito H, Takiuchi S, Taniyama Y, Nakatsuchi Y, Negoro S, Higashino Y, Okamura A, Masuyama T, Hori M, Fujii K, Minamino T: Alternation in the coronary blood flow velocity pattern in patients with no reflow and reperfused acute myocardial infarction. Circulation 1996; 94: 1269–1275 [DOI] [PubMed] [Google Scholar]
- 15. Kondo M, Nakano A, Saito D, Shimono Y: Assessment of “microvascular no‐reflow phenomenon” using technetium‐99m macroaggregated albumin scintigraphy in patients with acute myocardial infarction. J Am Coll Cardiol 1998; 32: 898–903 [DOI] [PubMed] [Google Scholar]
- 16. Gibson CM, Murphy SA, Rizzo MJ, Ryan KA, Marble SJ, McCabe CH, Cannon CP, Van de Werf F, Braunwald E: Relationship between TIMI frame count and clinical outcomes after thrombolytic administration. Circulation 1999; 99: 1945–1950 [DOI] [PubMed] [Google Scholar]
- 17. Hamada S, Nishiue T, Nakamura S, Sugiura T, Kamihata H, Miyoshi H, Imuro Y, Iwasaka T: TIMI frame count immediately after primary coronary angioplasty as a predictor of functional recovery in patients with TIMI 3 reperfused acute myocardial infarction. J Am Coll Cardiol 2001; 38: 666–671 [DOI] [PubMed] [Google Scholar]