Prognostic Value of Circulating Levels of Endothelin-1 in Patients After Acute Myocardial Infarction Undergoing Primary Coronary Angioplasty* Hon-Kan Yip, MD; Chiung-Jen Wu, MD; Hsueh-Wen Chang, PhD; Cheng-Hsu Yang, MD; Teng-Hung Yu, MD; Yen-Hsun Chen, MD; and Chi-Ling Hang, MD Background: The link between increased circulating level of endothelin (ET)-1 and adverse clinical outcomes after acute myocardial infarction (AMI) has been established. Current studies demonstrate that reperfusion therapy by either thrombolysis or primary percutaneous coronary intervention (PCI) can salvage myocardium, improving survival of AMI patients. However, whether reperfusion therapy by primary PCI can prevent the adverse effect of ET-1 on clinical outcomes in patients after AMI remains unclear. Therefore, this study examined the predictive value of circulating ET-1 levels on 30-day outcomes in ST-segment elevated AMI treated with primary PCI. Methods and results: We conducted a prospective cohort study of 186 consecutive patients with ST-segment elevated AMI of onset < 12 h who underwent primary PCI. Blood samples for plasma concentration of ET-1 were collected in the catheterization laboratory following vascular puncture. Patients were classified into a high group (group 1, ET-1 level > 0.632 pg/mL, n  93) and a low group (group 2, ET-1 level < 0.632 pg/mL, n  93) according to the median value of ET-1 after AMI. Univariate analysis demonstrated that the 30-day composite major adverse clinical outcomes (MACO) [advanced Killip score > 3], severe congestive heart failure (CHF) [New York Heart Association functional class 4], and 30-day mortality were strongly associated with high ET-1 level (> 0.632 pg/mL; p < 0.0001), unsuccessful reperfusion (final Thrombolysis in Myocardial Infarction flow < 2; p < 0.0001), low left ventricular ejection fraction (< 50%; p  0.0002), multivessel disease (p  0.005), and female gender (p  0.007). Multiple stepwise logistic regression analysis demon- strated that only high ET-1 level (p < 0.0001) and unsuccessful reperfusion (p < 0.0001) were independent predictors of 30-day MACO. Additionally, high ET-1 level (p  0.0021) along with unsuccessful reperfusion (p  0.008) and severe CHF (p < 0.0001) were significant independent predictors of increased 30-day mortality. Conclusions: A high circulating level of ET-1 is a strong independent predictor of 30-day MACO after ST-segment elevated AMI treated with primary PCI. (CHEST 2005; 127:1491–1497) Key words: acute myocardial infarction; endothelial-1; primary coronary angioplasty Abbreviations: AMI  acute myocardial infarction; CHF  congestive heart failure; DM  diabetes mellitus; ET  endothelin; LVEF  left ventricular ejection fraction; MACO  major adverse clinical outcomes; MB  myocardial blush; PCI  percutaneous coronary intervention; TIMI  Thrombolysis in Myocardial Infarction A cute myocardial infarction (AMI) is accompanied by metabolic and neurohormonal changes 1–3 that may relate to the severity of illness and clinical outcomes. 3 Rapidly advancing secretion of neurohor- mones by neuroendocrine systems is a physiologic response to myocardial damage in patients with AMI *From the Division of Cardiology (Drs. Yip, Wu, Yang, Yu, Chen, and Hang), Chang Gung Memorial Hospital; and Department of Biological Sciences (Dr. Chang), National Sun Yat-Sen Univer- sity, Kaohsiung, Taiwan, ROC. Manuscript received August 5, 2004; revision accepted Novem- ber 9, 2004. Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal. org/misc/reprints.shtml). Correspondence to: Chi-Ling Hang, MD, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hos- pital, Kaohsiung, 123, Ta Pei Rd, Niao Sung Hsiang, Kaohsiung Hsien, 83301, Taiwan, ROC; e-mail: tang@adm.cgmh.org.tw clinical investigations www.chestjournal.org CHEST / 127 / 5 / MAY, 2005 1491 Downloaded From: http://journal.publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/22025/ on 04/10/2017