engleski

Persistent oxidative stres in STEMI patients treated with primary PCI

Cardiovascular diseases, especially acute myocardial infarction with ST elevation (STEMI) still represent growing burden in western countries. New reperfusion techniques, such as primary percutaneous intervention (PCI) improved survival and quality of life of these patiens but there are many of pathophysiological mechanisams still unceratin. One of these is so-called ischemia-reperfusion injury wich represents secondary oxidative injury due to free radicals attack when myocardial ischemic damage is followed by urgent reperfusion. The aim of this study was to investigate level of oxidative stress in early as well as in late phases of STEMI treated with urgent reperfusion. We investigated 32 patients with diagnosis of STEMI in whom primary PCI was performed. Diagnosis of STEMI and decision to perform PCI was established by using current European Society of Cardiology guidelines. Blood was taken from the cubital vein prior to primary PCI (OV), two hours (I), four hours (II), three days (III) and seven days (IV) after PCI. The level of oxidative stress was measured by determinating total serum peroxide by using enzymatic in vitro diagnostic assay (LDN, Germany) and total antioxidant capacity by using ANTIOX-CAP assay (LDN, Germany). The statistical significance of the concentration evolution of peroxides and antioxidant capacity was calculated using the Chi- square test. Following PCI, levels of peroxides increased constantly in a linear manner reaching a peak level at time point IV with 282% ± 45% of to the initial value. The rise was found to be statistically significant (p<0.01). Consequently, the antioxidant capacity decreased to approximately 87% of the initial value (p<0, 001) and further dropped significantly (p<0.05) to 82% at time point IV . Oxidative stress plays important, but still uncertain, role in pathophysiology in acute myocardial infarction. Our data suggest constant rise in total peroxide activity with consumption of antioxidants even seven days after succesfull early reperfusion (PCI). Patophysiologic mechanism is not clear but there are indices that inflammation plays important role since major products of oxidative stress are removed by activated macrophages which are further potential source of new free radicals. The impact of oxidative stress on STEMI survival is unclear and further investigation is needed to clear this issue.

oxidative stres; STEMI; Primary PCI

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