Predictive value of oxidative, antioxidative, and inflammatory status for left ventricular systolic recovery after percutaneous coronary intervention for ST-segment elevation myocardial infarction

Aksoy, Fatih; Baş, Hasan Aydin; Bağcı, Ali; Savaş, Hasan Basri; Özaydın, Mehmet

doi:10.1590/1806-9282.20220300

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Revista da Associação Médica Brasileira

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Original Article • Rev. Assoc. Med. Bras. 68 (10) • 2022 • https://doi.org/10.1590/1806-9282.20220300 copy

Predictive value of oxidative, antioxidative, and inflammatory status for left ventricular systolic recovery after percutaneous coronary intervention for ST-segment elevation myocardial infarction

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

This study aimed to evaluate the association between left ventricular ejection fraction recovery and the total oxidant status, total antioxidant capacity, and high-sensitivity C-reactive protein levels.

METHODS:

A total of 264 ST-elevation myocardial infarction patients were classified into two groups according to baseline and 6-month follow-up left ventricular systolic function: reduced and recovery systolic function. Predictors of the recovery of left ventricular ejection fraction were determined by multivariate regression analyses.

RESULTS:

Multivariable analysis indicated that oxidative status index, baseline left ventricular ejection fraction and peak creatine-kinase myocardial bundle level, and high-sensitivity C-reactive protein were independently associated with the decreased of left ventricular ejection fraction at 6-month follow-up.

CONCLUSION:

Oxidative stress and inflammation parameters were detrimental to the recovery of left ventricular ejection fraction in patients with ST-elevation myocardial infarction.

KEYWORDS:
Ventricular dysfunction; Oxidants; Antioxidants; ST elevation myocardial infarction

		Group I (n=128)	Group II (n=136)	p-value
Baseline characteristics
	Female gender, n (%)	27 (21.1)	25 (18.4)	0.345
	Diabetes mellitus, n (%)	31 (24.2)	39 (28.7)	0.248
	Hypertension, n (%)	65 (50.8)	55 (40.4)	0.059
	Hyperlipidemia, n (%)	33 (25.8)	31 (22.8)	0.336
	Smoking, n (%)	74 (57.8)	88 (64.7)	0.153
	Obesity, n (%)	46 (35.9)	52 (38.2)	0.398
	Age (years)	64.8±12.7	61.1±12.7	0.017
	Systolic blood pressure (mmHg)	123.00±26.6	123.6±29.0	0.849
	Diastolic blood pressure (mmHg)	74.4±15.8	73.5±14.1	0.634
	Heart rate (bpm)	79.6±19.0	75.9±16.9	0.96
	Weight (kg)	73.2±13.5	76.3±12.4	0.056
	Length (cm)	165.64±7.5	167.1±7.5	0.108
	BMI	26.2±4.0	26.8±3.9	0.235
	Waist circumference (cm)	91.6±8.3	93.5±7.6	0.06
Previous treatment, n (%)
	RAS blockers	45 (18.0)	8 (16.0)	0.458
	β-Blockers	25 (19.5)	17 (12.5)	0.082
	Statins	19 (14.8)	14 (10.3)	0.176
Medication at discharge, n (%)
ACEi/ARBs
	β-Blockers	125 (98)	134 (99)	0.481
	Statins	121 (95)	127 (94)	0.483
	Antiplatelet	121 (95)	131 (97)	0.430
	Aldosterone antagonists	128 (100)	136 (100)	0.622
	Diuretics	40 (31)	13 (10)	<0.001
Device therapy, n (%)
	Cardiac resynchronization therapy	20 (15)	4 (3)	<0.001
	Implantable-cardioverter defibrillator	8 (7)	2 (2)	<0.001
Localization of MI, n (%)				<0.001
	Anterior	80 (62.5)	47 (37.6)
	Nonanterior	48 (37.5)	89 (65.4)
Infarct-related artery, n (%)				<0.001
	LAD	70 (66.0)	46 (38.0)
	Cx	13 (12.3)	19 (15.7)
	RCA	23 (21.7)	56 (46.3)
	Duration of CCU stay (day)	2.2±0.8	2.0±0.5	0.02
Laboratory findings
	Total antioxidant capacity	1.30±0.2	1.51±0.2	<0.001
	Total oxidant capacity	29.55±5.72	27.69±4.99	0.005
	OSI	23.51±6.32	18.99±5.50	<0.001
	hs-CRP (mg/L), median (IQR)	38.5 (8.7–60.00)	12.7 (6.72–15.00)	<0.001
	Uric acid (mg/dL)	6.5±1.6	5.9±1.3	0.001
	LDL (mg/dL)	108.2±36.5	107.3±34.4	0.843
	HDL (mg/L), median (IQR)	43.00 (35.00–48.00)	39.00 (33.00–44.00)	0.006
	Trigliserit (mg/dL)	123.2±62.9	152.6±126	0.017
	Total cholesterol (mg/dL)	175.8±41.6	176.1±42.4	0.959
	Initial creatinine (mg/dL)	1.1±0.3	1.0±0.2	0.004
	BUN	21.08±8.62	17.8±5.8	< 0.001
	Initial glucose (mg/dL)	179.3±100	167.4±77	0.280
	Hemoglobin (mg/dL)	14.3±2.6	14.2±1.7	0.802
	Platelet count	237±80	233±66	0.659
	Initial CK-MB (U/L)	36.5 (22.00–69.75)	29.00 (20.00–50.00)	0.009
	Initial troponin (ng/mL)	0.18 (0.40–0.58)	0.09 (0.01–0.44)	0.037
	Peak CK-MB (U/L)	250.00 (100.00–368.00)	135.00 (81.00–234.00)	<0.001
	Peak troponin (ng/mL)	5.5 (2.8–9.4)	3.1 (1.1–5.9)	< 0.001
Echocardiographic parameters
	LV diastolic diameter (mm)	50.8±4,5	48.5±3.5	<0.001
	LV systolic diameter (mm)	36.6±4.9	32.2±5.0	<0.001
	IVS (mm)	11.6±1.1	11.3±1.1	0.07
	Left atrial diameter (mm)	40.3±3.2	39.4±3.7	0.04
	LV ejection fraction at baseline (%)	28.9±4.0	32.2±4.0	< 0.001
	LV ejection fraction in the first year (%)	34.8±4.3	48.8±4.5	<0.001
	LV mass index (g/m)	117±33	104±32	<0.001

	Unadjusted odds ratio	Confidence interval	p-value	Adjusted odds ratio	Confidence interval	p-value
TOS	1.05	1.00–1.09	0.017
TAS	0.05	0.02–0.13	<0.001
OSI	1.14	1.09–1.19	<0.001	1.12	1.06–1.18	<0.001
Age	1.03	1.01–1.04	0.002
ACEi	3.48	1.39–8.67	0.007
CK-MB peak	1.004	1.002–1.005	<0.001	1.004	1.002–1.006	<0.001
Troponin peak	1.06	1.01–1.12	0.014
BUN	1.06	1.02–1.10	0.001
Uric acid	1.27	1.07–1.50	0.005
hs-CRP	1.01	1.01–1.02	<0.001	1.016	1.005–1.028	0.006
Heart rate	1.01	0.99–1.02	0.07
LV ejection fraction (baseline)	0.80	0.75–0.85	<0.001	0.85	0.79–0.91	<0.001

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[1] *Corresponding author: dr.aksoy@hotmail.com