Introduction:
Impaired myocardial reperfusion after successful percutaneous coronary intervention (PCI) is an important determinant of prognosis of patients with ST elevation myocardial infarction (STEMI). Neutrophil extracellular traps (NETs) are toxic DNA-protein complexes, upregulated in pro-thrombotic states and may induce endothelial injury.
Aim:
We aimed to assess in systemic and culprit coronary plasma, the level of NETs and their relationship with microvascular perfusion after PCI.
Methods:
Forty-nine STEMI patients treated with thrombectomy and PCI were enrolled. Patients with past history of coronary revascularization were excluded. Systemic blood was drawn at baseline and post PCI, and from the culprit lesion during thrombectomy. NETs and extracellular histone-DNA (E-DNA) were measured by capture ELISA (myeloperoxidase-DNA complex, histone-DNA complex, respectively). Corrected thrombolysis in MI (TIMI) frame count (cTFC) was calculated from coronary angiography.
Results:
The relation between NETs and cTFC is summarized in the figure. Both NETs and E-DNA were highest in culprit lesion plasma (p<0.05). Baseline and post-PCI levels of NETs were similar (p=0.56). Baseline, aspirate, and post-PCI NETs levels were inversely correlated with cTFC (ρ=-0.43, -0.31, -0.39, respectively, all p<0.05), and baseline NETs was an independent predictor of cTFC (β=-0.40, p=0.04), not age, gender, total ischemia time or troponin T level at admission. All E-DNA levels positively correlated with troponin T at admission (ρ=0.58, 0.47, 0.38, p<0.05, respectively), and were higher post PCI than at baseline (p<0.01), suggesting a reflection of myocardial damage. E-DNA showed no correlation with cTFC.
Conclusions:
Prior to PCI, baseline NETs level predict impaired reperfusion and may assist in tailored therapy and follow up.
Neutrophil extracellular traps and dsDNA predict outcomes among patients with ST-elevation myocardial infarction
