Lipidomic Predictors of Coronary No-Reflow

Abstract

The ‘no-reflow’ phenomenon (NRP) after primary percutaneous coronary intervention (PCI) is a serious complication among acute ST-segment elevation myocardial infarction (STEMI) patients. Herein, a comprehensive lipidomics approach was used to quantify over 300 distinct molecular species in circulating plasma from 126 patients with STEMI before and after primary PCI. Our analysis showed that three lipid classes: phosphatidylcholine (PC), alkylphosphatidylcholine (PC(O)), and sphingomyelin (SM), were significantly elevated (p < 0.05) in no-reflow patients before primary PCI. The levels of individual fatty acids and total fatty acid levels were significantly lower (p < 0.05) in no-reflow subjects after PCI. The grouping of patients based on ECG ST-segment resolution (STR) also demonstrated the same trend, confirming the possible role of these differential lipids in the setting of no-reflow. Sphingomyelin species, SM 41:1 and SM 41:2, was invariably positively correlated with corrected TIMI frame count (CTFC) at pre-PCI and post-PCI. The plasma levels of SM 42:1 exhibited an inverse association (p < 0.05) consistently with tumor necrosis factor-alpha (TNF-α) at pre-PCI and post-PCI. In conclusion, we identified plasma lipid profiles that distinguish individuals at risk of no-reflow and provided novel insights into how dyslipidemia may contribute to NRP after primary PCI.

Tongxinluo capsule as a multi-functional traditional Chinese medicine in treating cardiovascular disease: A review of components, pharmacological mechanisms, and clinical applications

“…Non reflow after percutaneous coronary intervention (PCI) refers to the failure of coronary artery blood flow to return to normal after PCI, resulting in the myocardium remaining in an ischemic state. This may be due to the incomplete dissolution or re formation of blood clots [ 242 ]. TXL is one of the preventive strategies for cardiovascular events after PCI and is widely used in China, but its effectiveness and safety have not been systematically evaluated.…”

Coronary No-Reflow after Primary Percutaneous Coronary Intervention—Current Knowledge on Pathophysiology, Diagnosis, Clinical Impact and Therapy

“…Another CMR imaging study showed modest association (adjusted odds ratio of 1.02) between elevated low-density lipoprotein (LDL) cholesterol level and microvascular injury in 235 patients with STEMI undergoing primary PCI [251]. A recent lipidomics study showed that phosphatidylcholine, alkylphosphatidylcholine, and sphingomyelin, were significantly elevated in plasma of patients with STEMI who developed CNR after primary PCI [252]. Despite well-known deleterious effects of smoking on vasculature, including endothelial dysfunction, vascular remodeling, increased thrombogenicity and proinflammatory action [253], recent CMR imaging studies in reperfused patients with STEMI did not show a significant difference in the presence or extent of MVO in smokers vs. nonsmokers [254][255][256].…”