The Relationship Between Inflammation,Oxidative Stress And Myocardial Perfusion In Patients With ST-segment Elevation Myocardial Infarction

Objective To explore the influence factors of poor myocardial perfusion,and the relationship between inflammation,oxidative stress and myocardial perfusion in patients with ST-segment elevation myocardial infarction(STEMI)after primary percutaneous coronary intervention(PCI).Methods(1)143 patients with first STEMI who were underwent primary PCI within 12 hours were investigated.Among the patients,there are 113 males and 30 females,and the average age was 57.80±11.35 years old.According to the sum-ST-segment resolution(sum STR)and TIMI myocardial perfusion grade(TMP)after primary PCI,all patients were divided into two groups,well myocardial perfusion group(sum STR?50% or TMP 2~3 grade)and poor myocardial perfusion group(sum STR<50% and TMP 0~1 grade).The influence factors between two groups were collected and analyzed,including sex,age,pain to balloon time,blood pressure on admission,left ventricular ejection fraction,leukocyte count,neutrophil ratio,high-sensitivity C-reactive protein,blood lipid,and the history of hypertension,diabetes mellitus and so on.(2)The venous blood of 71 patients with STEMI were collected when they were on admission.Among the patients,50 patients were divided into well myocardial perfusion group,and 21 patients into poor myocardial perfusion group.The platelet-leukocyte aggregation(PLA)? platelet-neutrophile aggregation(PNA)? platelet-monocyte aggregation(PMA)and platelet-lymphocyte aggregation(PLy A)were measured by using flow cytometry.The malondialdehyde(MDA),an index of oxidative stress level,and superoxide dismutase(SOD),an antioxidant index,were measured by means of chemical colorimetry.20 patients with stable angina pectoris(SAP)and 20 patients without any coronary disease(control group)were taken to compare the differences of PLA?PNA?PMA?PLy A?MDA and SOD levels among the three groups.Results(1)The leucocyte count(P=0.001),neutrophil ratio(P=0.001)and high-sensitivity C-reactive protein(P<0.001)of poor myocardial perfusion group were significantly higher than well myocardial perfusion group.(2)Multiple linear regression analysis(stepwise)showed that neutrophil ratio was independent risk factor of sum STR in STEMI patient after primary PCI(P<0.001).(3)Compared with the SAP group and control group,STEMI group has higher levels of PLA?PNA?PMA and MDA(P<0.05).Compared with control group,STEMI group has higher levels of PLy A and SOD.There are no significant differences of PLy A level and SOD level between STEMI group and SAP group(P>0.05).(4)Compared with well myocardial perfusion group,poor myocardial perfusion group has higher levels of PLA(P=0.036)?PNA(P=0.035)?PMA(P=0.047)and MDA(P=0.023),and there are no differences of PLy A and SOD levels between the two groups(P>0.05).Conclusion(1)The increase of leucocyte count,neutrophil ratio and high-sensitivity C-reactive protein are related to the poor myocardial perfusion after primary PCI.(2)The increase of neutrophil ratio is an independent risk factor of poor myocardial perfusion.(3)The patients with more serious coronary heart disease have higher levels of PLA ?PNA?PMA and MDA.The levels of PLA ?PNA?PMA and MDA measured on admission are related to the severity of coronary heart disease.(4)The patients with poor myocardial perfusion after primary PCI have higher levels of PLA ?PNA?PMA and MDA.It indicates that inflammation,oxidative stress are related to the poor myocardial perfusion in patients with STEMI after primary PCI.