Iron deficiency in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
Int J Cardiol
; 300: 14-19, 2020 02 01.
Article
em En
| MEDLINE
| ID: mdl-31399299
ABSTRACT
BACKGROUND:
Iron deficiency (ID) is a known co-morbidity and a potential therapeutic target in heart failure. Whether ID is frequent also in ST-segment elevation acute myocardial infarction (STEMI) patients and is associated with worse in-hospital outcomes has never been evaluated.METHODS:
We defined ID as a serum ferritinâ¯<â¯100⯵g/L or transferrin saturationâ¯<â¯20% at hospital admission. We assessed the association between ID and the primary endpoint (a composite of in-hospital mortality and Killip classâ¯≥â¯3). We explored the potential association between ID, circulating cell-free mitochondrial DNA (mtDNA), and cardiac magnetic resonance (CMR) parameters.RESULTS:
Four-hundred-twenty STEMI patients undergoing primary percutaneous coronary intervention (pPCI) were included. Of them, 237 (56%) had ID. They had significantly higher admission high-sensitivity troponin and mtDNA levels as compared to non-ID patients (145⯱â¯35 vs. 231⯱â¯66â¯ng/L, Pâ¯<â¯0.001; 917 [404-1748] vs. 1368 [908-4260] copies/µL; Pâ¯<â¯0.003, respectively). A lower incidence of the primary endpoint (10% vs. 18%, Pâ¯=â¯0.01) was observed in ID patients (adjusted OR 0.50 [95% CI 0.27-0.93]; Pâ¯=â¯0.02). At CMR (nâ¯=â¯192), ID patients had a similar infarct size (21⯱â¯18 vs. 21⯱â¯19â¯g; Pâ¯=â¯0.95), but a higher myocardial salvage index (0.56⯱â¯0.30 vs. 0.43⯱â¯0.27; Pâ¯=â¯0.002), and a smaller microvascular obstruction extent (3.6⯱â¯2.2 vs. 6.9⯱â¯3.9â¯g; Pâ¯<â¯0.001).CONCLUSIONS:
Iron deficiency is frequent in STEMI patients, it is coupled with mitochondrial injury, and, paradoxically, with a better in-hospital outcome. This unexpected clinical result seems to be associated with a smaller myocardial reperfusion injury. The mechanisms underlying our findings and their potential clinical implications warrant further investigation.Palavras-chave
Texto completo:
1
Bases de dados:
MEDLINE
Assunto principal:
Anemia Ferropriva
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Intervenção Coronária Percutânea
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Infarto do Miocárdio com Supradesnível do Segmento ST
Tipo de estudo:
Observational_studies
/
Risk_factors_studies
Limite:
Aged
/
Female
/
Humans
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Male
/
Middle aged
País/Região como assunto:
Europa
Idioma:
En
Revista:
Int J Cardiol
Ano de publicação:
2020
Tipo de documento:
Article
País de afiliação:
Itália