Endothelial dysfunction in young patients with acute ST-elevation myocardial infarction

Abstract

Endothelial dysfunction may be particularly important in the pathogenesis of young patients with acute myocardial infarction (AMI), because they have different clinical characteristics compared with older patients. We investigated endothelial function in relation to AMI in this young age group. From January 2005 to March 2008, 29 of 31 consecutive patients with acute ST-elevation myocardial infarction (STEMI) who were <40 years old and received direct percutaneous coronary intervention (PCI) were enrolled in the study. We compared the coronary risk factors and flow-mediated vasodilation (FMD) in the brachial artery between the acute STEMI patients and 29 age- and gender-matched controls that did not have AMI. Baseline brachial artery diameter and responses to glyceryl trinitrate were similar between the two groups. In contrast, FMD was significantly lower in the young acute STEMI group than in the control (3.47 ± 4.08 vs. 7.45 ± 4.67%, p = 0.001) and correlated with the Thrombolysis in Myocardial Infarction (TIMI) risk score. The impaired FMD in the acute STEMI group was independent of smoking, hyperlipidemia, hypertension, nitrate use, or body mass index. In multiple logistic regression analysis, only FMD and age, not traditional cardiovascular risk factors, were found to be significantly associated with acute STEMI (odds ratio = 0.75, 95% CI 0.63-0.90, p < 0.01). In conclusion, independent of conventional risk factors, severe endothelial dysfunction occurs in young acute STEMI patients and correlates with TIMI score. In addition to age, impaired FMD is the only significant factor associated with acute STEMI in this young population.

A Single Session of Neuromuscular Electrical Stimulation Enhances Vascular Endothelial Function and Peripheral Blood Circulation in Patients With Acute Myocardial Infarction

“…5,6) Given that vascular endothelial dysfunction is strongly associated with poor prognosis in patients with AMI, 7,8) preventing the exacerbation of vascular endothelial function is important for the secondary prevention of AMI. Although many studies have reported that aerobic exercise performed as an exercise therapy improves vascular endothelial function, 9,10) it is likely difficult for patients with AMI to perform vigorous exercise therapy early after admission due to cardiovascular instability and autonomic imbalance.…”

“…Therefore, a new practicable intervention that improves their vascular endothelial function, as an alternative to exercise therapy, is needed. NMES can be applied to patients with unstable hemodynamic status and autonomic imbalance because they can re-Vol 57 No 6 EFFECTS OF ELECTRICAL STIMULATION IN AMI PATIENTS ceive NMES therapy on bed without postural changes. However, the immediate effects of NMES on vascular endothelial function in patients with AMI are unknown.…”

Prostanoids suppress the coronary vasoconstrictor influence of endothelin after myocardial infarction

“…The withdrawal of ET-mediated vasoconstriction during exercise in the normal heart was shown to be mediated by NO and prostanoids (37); these data indicate that recruitment of coronary flow reserve during exercise depends critically on a healthy well-functioning endothelium. Since endothelial dysfunction has been shown to be present after MI (4,47,49), we investigated in the present study if the contributions of the three main endothelial vasoactive systems (NO, prostanoids, and ET) to control of coronary resistance vessel tone in remodeled myocardium were altered at rest and/or during exercise.…”

Assessment of the relation between initial culprit vessel patency in acute ST-elevation myocardial infarction and endothelial function

“…In 29 young STEMI patients (age <40 years), Chen et al assessed flow-mediated vasodilation of the brachial artery and found more endothelial dysfunction with higher age 32 . In the present study, we examined 71 STEMI patients with a mean age of 57 years (ranging from 38 to 76 years) with the RH-PAT method to investigate a different research issue.…”