Role of biomarkers of myocardial injury and inflammation in predicting ischemia-reperfusion injury in patients with ST-segment elevation acute coronary syndrome undergoing endovascular revascularization

Aim. To evaluate the informative value of biomarkers (cardiac troponin l (cTnl), high-sensitivity C-reactive protein (hsCRP), N-terminal pro-brain natriuretic peptide (NTproBNP), stimulating growth factor (ST2)) as laboratory markers of myocardial ischemia-reperfusion injury in patients with ST-segment elevation acute coronary syndrome (STEACS) undergoing endovascular revascularization.

Material and methods. The study included 115 patients with STEACS who underwent endovascular myocardial revascularization. To identify the informative value of biomarkers, the levels of cTnl, NTproBNP, hsCRP, sST2 were analyzed at baseline, as well as after reperfusion therapy on the 2nd (cTnl) and 5th (sST2, hsCRP, NTproBNP) days. Contrast-enhanced cardiac magnetic resonance imaging was performed 5 days after endovascular intervention.

Results. Microvascular obstruction was detected in 54 patients (47%), of which 24 (44%) patients had a combination of microvascular obstruction and myocardial hemorrhage. ln 61 cases (53%), no microvascular damage was registered. lt was found that with an increase in the threshold initial NTproBNP levels >590 pg/ml, the odds ratio (OR) of myocardial reperfusion injury was 12,2 (95% confidence interval (CI), 4,81-30,92, p<0,001). In addition, we analyzed biomarker levels in the early period after myocardial infarction, at which threshold values of reperfusion injury parameters were established as follows: for cTnI >8,1 ng/ml, OR=7,17 (95% CI, 3,11-16,53, p=0,001); for hsCRP >14 mg/L, OR=12,71 (95% CI, 5,03-32,08, p=0,001); for NTproBNP >334 pg/ml, OR=11,8 (95% CI, 4,88-28,59, p=0,001); for sST2 >41 ng/ml, OR=7,17 (95% CI, 3,11-16,53, p=0,001). According to multivariate analysis, predictors of microvascular injury were the initial NTproBNP values, as well as the cTnI, hsCRP, and sST2 values in the early postinfarction period (sensitivity — 89,5%, specificity — 83,3%).

Conclusion. Thus, the initial NTproBNP, as well as cTnI, hsCRP, sST2 values after percutaneous coronary intervention are more informative for assessing the risk of microvascular damage.

1. Sezer M, Royen N, Umman B, et al. Coronary Microvascular Injury in Reperfused Acute Myocardial Infarction: A View From an Integrative Perspective. Journal of the American Heart Association. 2018;7:e009949. doi:10.1161/JAHA.118.009949.

2. Bochaton T, Lassus J, Paccalet A, et al. Association of myocardial hemorrhage and persistent microvascular obstruction with circulating inflammatory biomarkers in STEMI patients. PloS ONE. 2021;16(1):e0245684. doi:10.1371/journal.pone.0245684.

3. Niccoli G, Scalone G, Lerman A, Crea F. Coronary microvascular obstruction in acute myocardial infarction. Eur Heart J. 2016;37(13):1024-33. doi:10.1093/eurheartj/ehv484.

4. Frolov AA, Pochinka IG, Shakhov BE, et al. Coronary microvascular obstruction (the no-reflow phenomenon) during percutaneous coronary interventions in patients with myocardial infarction. Circulation Pathology and Cardiac Surgery. 2020;24(1):18-27. (In Russ.) doi:10.21688/1681-3472-2020-1-18-27.

5. Konijnenberg SF, Damman P, Duncker D, et al. Pathophysiology and diagnosis of coronary microvascular dysfunction in ST-elevation myocardial infarction. Cardiovasc Res. 2020;116(4):787-805. doi:10.1093/cvr/cvz301.

6. Rusak TV, Gelis LG, Medvedeva EA, et al. Risk factors of reperfusion injury of the myocardium during endovascular revascularization in patients with acute coronary syndrome. Cardiology in Belarus. 2020;12(5):639-55. (In Russ.) doi:10.34883/PI.2020.12.5.003.

7. Gelis LG, Miadzvedzeva AA, Shibeko NA. Acute coronary syndrome and biomarkers of cardiovascular risk. Minsk: Medisont, 2018. Р. 344. (In Russ.) ISBN: 978-985-7199-52-5.

8. Aleksova A, Paldino A, Beltrami AP, et al. Cardiac Biomarkers in the Emergency Department: The Role of Soluble ST2 (sST2) in Acute Heart Failure and Acute Coronary Syndrome — There is Meat on the Bone. J. Clin. Med. 2019;8(2):270-82. doi:10.3390/jcm8020270.

9. Kali A, Cokic I, Tang R, et al. Persistent Microvascular Obstruction After Myocardial Infarction Culminates in the Confluence of Ferric Iron Oxide Crystals, Proinflammatory Burden, and Adverse Remodeling. Circ Cardiovasc Imaging. 2016;9:e004996. doi:10.1161/CIRCIMAGING.115.004996.

10. Feistritzer H, Reinstadler SJ, Klug G, et al. Multimarker approach for the prediction of microvascular obstruction after acute ST-segment elevation myocardial infarction: a prospective, observational study. BMC Cardiovasc Disord. 2016;16(1):239-48. doi:10.1186/s12872-016-0415-z.