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Acute myocardial infarction is associated with endothelial glycocalyx and cell damage and a parallel increase in circulating catecholamines.
MedLine Citation:
PMID:  23433357     Owner:  NLM     Status:  Publisher    
ABSTRACT: INTRODUCTION: Excessive sympathoadrenal activation in critical illness contributes directly to organ damage and high concentrations of catecholamines damage the vascular endothelium. This study investigated associations between potential drivers of sympathoadrenal activation, circulating catecholamines and biomarkers of endothelial damage and outcome in ST segment elevation myocardial infarction (STEMI)-patients, hypothesizing that the catecholamine surge would reflect shock degree and correlate with biomarkers of endothelial damage. METHODS: This was a prospective study of 678 consecutive STEMI-patients admitted to a single high-volume invasive heart centre for primary percutaneous coronary intervention (pPCI) from September 2006-July 2008. Blood samples were drawn immediately before pPCI. Plasma adrenaline, noradrenaline, syndecan-1 and thrombomodulin were measured retrospectively with complete data in 571 patients (84%). Median follow-up time was 28 (IQR 23-34) months. Follow-up was 99.7% complete. Outcomes were all-cause and cardiovascular mortality, re-myocardial infarction and admission due to heart failure (HF). RESULTS: Circulating noradrenaline and adrenaline correlated weakly but independently with syndecan-1 (rho=0.15 and rho=0.13, both p<0.01) and thrombomodulin (rho=0.11 and rho=0.17, both p<0.01), biomarkers of glycocalyx and endothelial cell damage, respectively. Considering biomarkers, patients with shock pre-pPCI had higher adrenaline and syndecan-1 and patients admitted to ICU post-pPCI had higher syndecan-1 (all p<0.05), and in the shocked patients (n=51) catecholamines correlated strongly with thrombomodulin and syndecan-1 (rho=0.31-0.42, all p<0.05). During follow-up, 78 (14%) patients died (37 cardiovascular deaths) and 65 (11%) were admitted with HF. By multivariate Cox proportional hazards analyses, one quartile higher plasma adrenaline was weakly but independently associated with both 30-day and long term mortality and HF (30-day all-cause mortality Hazard Ratio (95% CI) 1.39 (1.01-1.92), p=0.046; 30-day HF 1.65 (1.17-2.34), p=0.005; long-term cardiovascular mortality 1.49 (1.08-2.04), p=0.014). Furthermore, one quartile higher syndecan-1 was also weakly independently associated with long-term all cause mortality (1.26 (1.02-1.57), p=0.034). CONCLUSIONS: In STEMI-patients treated with pPCI, catecholamines correlated weakly with biomarkers of endothelial damage, with the strongest correlations and highest adrenaline and syndecan-1 levels in shocked patients. Furthermore, adrenaline and syndecan-1 were weakly independently associated with mortality and HF. Acute MI appears to cause significant endothelial cell and glycocalyx injury and a parallel increase in circulating catecholamines.
Sisse R Ostrowski; Sune H Pedersen; Jan S Jensen; Rasmus Mogelvang; Par I Johansson
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-2-22
Journal Detail:
Title:  Critical care (London, England)     Volume:  17     ISSN:  1466-609X     ISO Abbreviation:  Crit Care     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-2-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9801902     Medline TA:  Crit Care     Country:  -    
Other Details:
Languages:  ENG     Pagination:  R32     Citation Subset:  -    
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