Key result
Spontaneous reperfusion in STEMI patients was associated with significantly increased peripheral blood succinate levels (0.141 vs 0.069 mmol/L) compared to those without, but these levels did not correlate with myocardial infarct size.
Why the study?
Coronary sinus blood is not routinely obtained in the CathLab, so it was unknown whether peripheral plasma concentrations of succinate and other metabolites during coronary revascularization correlate with edema volume or infarct size in STEMI patients.
Does peripheral plasma succinate concentration correlate with myocardial infarct size or area at risk in STEMI patients undergoing PPCI?
Observational (n=111)
No
Does peripheral plasma succinate concentration correlate with myocardial infarct size or area at risk in STEMI patients undergoing PPCI?
Early peripheral plasma levels of succinate do not correlate with myocardial infarct size or area at risk in STEMI patients, limiting its utility as a prognostic biomarker.
Answers are grounded in this paper and cite their sources.
Limits succinate's utility as infarct size biomarker in STEMI; leaves open its link to spontaneous reperfusion for mechanistic study.
Succinate is enhanced during initial reperfusion in blood from the coronary sinus in ST-segment elevation myocardial infarction (STEMI) patients and in pigs submitted to transient coronary occlusion. Succinate levels might have a prognostic value, as they may correlate with edema volume or myocardial infarct size. However, blood from the coronary sinus is not routinely obtained in the CathLab. As succinate might be also increased in peripheral blood, we aimed to investigate whether peripheral plasma concentrations of succinate and other metabolites obtained during coronary revascularization correlate with edema volume or infarct size in STEMI patients. Plasma samples were obtained from peripheral blood within the first 10 min of revascularization in 102 STEMI patients included in the COMBAT-MI trial (initial TIMI 1) and from 9 additional patients with restituted coronary blood flow (TIMI 2). Metabolite concentrations were analyzed by 1H-NMR. Succinate concentration averaged 0.069 ± 0.0073 mmol/L in patients with TIMI flow ≤ 1 and was significantly increased in those with TIMI 2 at admission (0.141 ± 0.058 mmol/L, p < 0.05). However, regression analysis did not detect any significant correlation between most metabolite concentrations and infarct size, extent of edema or other cardiac magnetic resonance (CMR) variables. In conclusion, spontaneous reperfusion in TIMI 2 patients associates with enhanced succinate levels in peripheral blood, suggesting that succinate release increases overtime following reperfusion. However, early plasma levels of succinate and other metabolites obtained from peripheral blood does not correlate with the degree of irreversible injury or area at risk in STEMI patients, and cannot be considered as predictors of CMR variables. Trial registration: Registered at www.clinicaltrials.gov (NCT02404376) on 31/03/2015. EudraCT number: 2015-001000-58.
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Consegal et al. (2023) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=111). Spontaneous reperfusion (initial TIMI flow ≥ 2) vs. Initial TIMI flow ≤ 1 was evaluated on Peripheral blood succinate concentration (p=<0.05). Spontaneous reperfusion in STEMI patients was associated with significantly increased peripheral blood succinate levels (0.141 vs 0.069 mmol/L) compared to those without, but these levels did not correlate with myocardial infarct size.
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