Correlative Analysis Between The Serum Irisin Level And No-reflow In Patients With Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

BackgroundAcute myocardial infarction( AMI) is the number one killer of human life and a common clinical emergency. It has the characteristics of sudden onset, high hospitalization rate, high disability rate and high mortality rate. It may lead to many fatal complications, include: cardiac rupture, heart failure, cardiac shock, malignant arrhythmia, etc. Percutaneous Coronary Intervention(PCI) in treatment of patients with AMI is the most important technique to open occluded artery, save the infarcted myocardium, myocardial revascularization. The no-reflow(NR) phenomenon significantly attenuates the beneficial impact of PCI in patients with AMI. No-reflow phenomenon is a common and serious complication following PCI. NR has an incidence varying between 10% and 40% after primary PCI with AMI patients. Once NR have occurred, the patients will have left adverse ventricular remodeling, ejection fraction decreased and malignant arrhythmia. Eventually increasing sudden death and other serious cardiovascular incidence.NR is a independent predictor of long-term cardiac malignant events in patients with AMI. If the prediction factor of NR can be found before PCI,early prevent it,will greatly reduce the incidence of no reflow and mortality, improve the success rate of treatment. Therefore, early discovery of NR are likely to have a significant impact on the outcome of PCI.At present, there were few predictor of NR in the clinical research, contains: Platelet distribution width, Troponin I level, Endothelin 1(ET-1) level, white blood cell count and Plasma high sodium peptide levels. Because of these factors, which are considered less relevant with NR and low-specificity, they can not be further verified and applied in clinical practice. Irisin is a novel skeletal muscle-derived protein. Irisin is primary produced within heart and skeletal muscle, especially heart muscle, which is the most important source of irisin, will influence the irisin level. Lots of studys show that Irisin closely associated with glucolipid metabolism and acute myocardial infarction. Serum irisin levels gradually decreased in AMI patients, the significant decrease of serum irisin might be potentially candidate marker for diagnosis of AMI. In our preliminary experiment, Irisin has been observed to decrease carotid artery arteriosclerosis clot, protect vascular endothelium directly and expand blood vessel. Therefore, on the basis of the potential protective effects that Irisin could exert on vascular function, we speculate that a reduced level of Irisin may contribute to the occurrence of no reflow. Up to the present time, there are few corresponding research about Irisin and NR in the world. Therefore, we measured serum irisin levels in NR group and compared the results with ischemia reperfusion group. To investigate the relationship between serum irisin level in AMI patients and NR, to provide evidence further for clinical diagnosis and treatment of NR.ObjectivesTo observe the relationship between serum Irisin level and no-reflow in emergency percutaneous coronary intervention with acute myocardial infarction patients at admission. To investigate the predictive value of serum Irisin level in patients with no-reflow after PCI with acute myocardial infarction.Methods1. A total of 185 hospitalized patients with acute myocardial infarction diagnosed in Our Hospital from February 2014 to February 2015, were admitted as subjects of experimental group of the study. The 16 patients, who did not need PCI treatment after coronary angiography examination, were excluded. After admitted to hospital, all patients were immediately finished medical history collection, physical examination and height, body weight index measurement. To complete laboratory testing within 2 hours, including: triglyceride, total cholesterol, HDL, LDL Pro-BNP, hs-CRP and serum creatinine, blood urea nitrogen, troponin I and myoglobin, creatine kinase isoenzyme and cardiac ultrasound examination, etc.2. Grouping: ①169 AMI patients undergoing PCI were divided into two groups according to TIMI flow grade and CTFC after PCI. No-reflow group were 40 patients with coronary artery forward flow<TIMI Ⅱ and CTFC>30 frame, reperfusion patients were control group(129 patients).②The plasma levels of Irisin were measured by ELISE, patients with lower Irisin(the lower quartile of Irisin level:Irisin<5062.68ng/m L, n=43) as Lower Irisin group. Patients with high Irisin(the uppest quartile of Irisin level, Irisin≥5062.68ng/m L, n=126) as Higher Irisin group.③According to chest pain symptoms onset time,the patients were divided into two subgroups, within 12 hours group and morethan 12 hours group. Each subgroups were divided into lower Irisin group and higher Irisin group according to the plasma levels of Irisin.3. All patients take orally immediately“Aspirin enteric-coated 300 mg,Ticagrelor 180 mg” on admission. 3ml of plasma samples were collected on emergency admission, then drawn into tubes containing EDTA. Afte 60 minutes at room temperature, the plasma samples were placed in Centrifuge at 3000 r/min to separate plasma. Then the centrifugal plasma were stored in EP tubes and frozen at-80℃ until testing. Plasma Irisin level were measured by ELISE.4. All statistical tests were performed with SPSS 19.0 statistics software. The count data were expressed as percentages, the measurement data were expressed as x ±s. Chi square test was used to analysis count date, t test was used to analysis measurement data between two groups. Univariate logistic regression analysis was used to analyze independent predictors of no reflow. After univariate logistic regression analysis, the significant variable(BMI、LVEF、hs-CRP、troponin-I、Irisin) were used multivariate logistic regression analysis method to analysis. P<0.05 was considered statistically significant difference.Results1. There were 40 patients in the no-reflow group. No-reflow occurred in 23.6% of the AMI patients after primary PCI(40/169). In the following basic information: age, gender, the main risk factors of coronary heart disease(diabetes, hypertension, smoking, blood lipids, obesity) and biochemical tests(urea, creatinine, BNP), there was no statistically significant difference in no-reflow group compared with normal blood flow group(all P>0.05). BMI, hs-CRP, High sensitivity C-reactive protein and troponin-I showed statistically significant difference between no-reflow group and normal blood flow group(P<0.05). After AMI, the level of serum Irisin in no-reflow group was significantly decreased compared with the control group(P<0.001).2. Between low Irisin group and high Irisin group, the low Irisin group has higher incidence of no-reflow compared with high Irisin group, there was statistically significant difference(P<0.05). In addition, compared with high Irisin group, BMI, Preoperative systolic pressure, hs-CRP, troponin-I, and Gensini score displayed statistically significant difference in low Irisin group.3. Within 12 hours group, the serum Irisin was gradually decreased compared with more than 12 huors group(P<0.05). In each subgroup, low Irisin group has higher incidence of no-reflow(P<0.05). Two low Irisin group comparison, there was no statistically significant difference in the incidence of no reflow and the level of serum Irisin. High Irisin group of morethan12 hours group, the incidence of no reflow was gradually decreased compared with low Irisin group of within12 hours group(P<0.05).4. Pearson-related analysis showed that the level of serum Irisin was negative correlated with CTFC, hs-CRP, troponin I, blood glucose, Gensini score, was positively correlated with systolic blood pressure and diastolic blood pressure(P<0.05). Multiple logistic analysis identified Irisin as the protective predictor of no-reflow after primary PCI in AMI(OR:0.861, 95%CI:0.793-0.909, P<0.05).5. There was higher diagnostic value of no-reflow when Irisin was at 6325.84ng/ml(area under ROC curve:0.843; Standard error: 0.031,P<0.001,95%CI:0.783-0.904).ConclusionsLow level of Irisin with AMI patients significantly increased the risks of no reflow, serum Irisin level may become a predictive factor for PCI in patients with acute myocardial infarction.