| 홍서나¹, 조향희², 문금이², 심두선²,정명호², 조정관², 박종춘², 강정채², 안영근² |
Background: Some patients with non-ST segment elevation myocardial infarction (NSTEMI) showed total occlusion (TO) of infarct related artery (IRA). We investigated the relation between the circulating endothelial progenitor cell (EPC) and TO of IRA of NSTEMI and clinical impact of TO of IRA in patients with NSTEMI.
Methods: We enrolled 112 patients (62.8±12.4 years, male 75.0 %) with NSTEMI who underwent percutaneous coronary intervention (PCI). The number of EPC and the levels of serum vascular endothelial growth factor (VEGF), macrophage chemoattractant protein (MCP-1), and interleukin-10 (IL-10) were measured in the peripheral blood before PCI. The follow-up LVEF was measured at 6 months after PCI. The patients were divided into two groups according to the finding of IRA (Group I: patients with TO of IRA, n=43; Group II: patients with non-TO of IRA, n=69).
Results: The level of peak troponin I was significantly higher in the group I than that of the group II (22.7±24.4 vs. 12.9±21.1 ng/mL, p=0.027). CD34+VEGFR2+ cells and CD45lowCD34+VEGFR2+ cells were significantly lower in the group I than those of the group II (263.8±186.2 vs. 447.1±345.4/106 leukocyte, p=0.023; 82.0±72.6 vs. 211.1±268.8/106 leukocyte, p=0.029). The levels of VEGF, MCP-1, and IL-10 were no significant differences. In subgroup analysis, patients with left ventricular ejection fraction (LVEF) ≤ 45%, the baseline LVEF was similar between the groups (35.2±7.3 vs. 36.1±6.0 %, p=0.138). At 6-month after PCI, the LVEF was improved significantly in the group II (36.1 % to 47.0%, p=0.015) but not in the group I (35.2 % to 39.5%, p=0.216). In multivariate analysis, circulating CD34+VEGFR2+ cell was an independent predictor of TO of IRA in patients with NSTEMI (OR, 4.25; 95% CI 1.09 to 16.44, p=0.038) and TO of IRA in NSTEMI was associated with LV functional improvement (OR, 1.78; 95% CI 1.03 to 3.57, p=0.033).
Conclusion: The TO of IRA in patients with NSTEMI was related to improvement of LVEF. The level of circulating EPCs were associated TO of IRA in patients with NSTEMI.
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