Key result
STEMI prior to reperfusion was associated with elevated DHA-derived oxylipins compared to controls, which correlated with peak troponin T (r=0.50, p=0.001) and rapidly reduced post-reperfusion.
Why the study?
Despite successful reperfusion with PPCI, myocardial cells die from ischemia/reperfusion injury, and the impact of coronary artery reperfusion on plasma oxylipins is unknown.
Does primary percutaneous coronary intervention alter plasma oxylipin profiles in patients with STEMI?
Observational
Does primary percutaneous coronary intervention alter plasma oxylipin profiles in patients with STEMI?
Plasma oxylipin profiles are significantly altered during STEMI and rapidly decrease following successful reperfusion, with the epoxide-to-diol ratio potentially predicting infarct size.
DHA oxylipin changes may mark STEMI severity; leaves open their role as post-PCI biomarkers pending prospective validation.
ST-segment elevation myocardial infarction (STEMI) occurs as a result of acute occlusion of the coronary artery. Despite successful reperfusion using primary percutaneous coronary intervention (PPCI), a large percentage of myocardial cells die after reperfusion, which is recognized as ischemia/reperfusion injury (I/R). There are rapid changes in plasma lipidome during myocardial reperfusion injury. However, the impact of coronary artery reperfusion on plasma oxylipins is unknown. This study aimed to investigate alterations in the oxylipin profiles of STEMI patients during ischemia and at various reperfusion time points following PPCI. Blood samples were collected from patients presenting with STEMI prior to PPCI (Isch, n = 45) and subsequently 2 h following successful reperfusion by PPCI (R-2 h, n = 42), after 24 h (R-24 h, n = 44), after 48 h (R-48 h, n = 43), and then 30 days post PPCI (R-30 d, n = 29). As controls, blood samples were collected from age- and sex-matched patients with non-obstructive coronary artery disease after diagnostic coronary angiography. High-performance liquid chromatography–mass spectrometry (HPLC-MS/MS) using deuterated standards was used to identify and quantify oxylipins. In patients presenting with STEMI prior to reperfusion (Isch group), the levels of docosahexaenoic acid (DHA)-derived oxylipins were significantly higher when compared with controls. Their levels were also significantly correlated with the peak levels of creatine kinase (CK) and troponin T(TnT) before reperfusion (CK: r = 0.33, p = 0.046, TnT: r = 0.50, p = 1.00 × 10−3). The total concentrations of oxylipins directly produced by 5-lipoxygenase (5-LOX) were also significantly elevated in the Isch group compared with controls. The ratio of epoxides (generated through epoxygenase) to diols (generated by soluble epoxide hydrolysis (sEH)) was significantly lower in the Isch group compared with the controls. Following reperfusion, there was an overall reduction in plasma oxylipins in STEMI patients starting at 24 h post PPCI until 30 days. Univariate receiver operating characteristic (ROC) curve analysis also showed that an elevated ratio of epoxides to diols during ischemia is a predictor of smaller infarct size in patients with STEMI. This study revealed a large alteration in plasma oxylipins in patients presenting with STEMI when compared with controls. Total oxylipin levels rapidly reduced post reperfusion with stable levels reached 24 h post reperfusion and maintained for up to 30 days post infarct. Given the shifts in plasma oxylipins following coronary artery reperfusion, further research is needed to delineate their clinical impact in STEMI patients.
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Solati et al. (2023) conducted an observational in ST-Segment Elevation Myocardial Infarction. STEMI and reperfusion by PPCI vs. Age- and sex-matched patients with non-obstructive coronary artery disease was evaluated on Plasma oxylipin levels. STEMI prior to reperfusion was associated with elevated DHA-derived oxylipins compared to controls, which correlated with peak troponin T (r=0.50, p=0.001) and rapidly reduced post-reperfusion.
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