Endothelin-1 and acute myocardial infarction: A no-reflow mediator after successful percutaneous myocardial revascularization

Giampaolo Niccoli, Gaetano Antonio Lanza, Sidney Shaw, Enrico Romagnoli, Domenico Gioia, Francesco Burzotta, Carlo Trani, Mario A. Mazzari, Rocco Mongiardo, Maria De Vita, Antonio G. Rebuzzi, Thomas F. Lüscher, Filippo Crea

Research output: Contribution to journalArticlepeer-review


Aims: No-reflow after a primary percutaneous coronary intervention (PCI) is associated with a high incidence of left ventricular (LV) failure and a poor prognosis. Endothelin-1 (ET-1) is a potent endothelium-derived vasoconstrictor peptide and an important modulator of neutrophil function. Elevated systemic ET-1 levels have recently been reported to predict a poor prognosis in patients with acute myocardial infarction (AMI) treated by primary PCI. We aimed to investigate the relationship between systemic ET-1 plasma levels and no-reflow in a group of AMI patients treated by primary PCI. Methods and results: A group of 51 patients (age 59±9.9 years, 44 males) with a first AMI, undergoing successful primary or rescue PCI, were included in the study. Angiographic no-reflow was defined as coronary TIMI flow grade ≤2 or TIMI flow 3 with a final myocardial blush grade ≤2. Blood samples were obtained from all patients on admission for ET-1 levels measurement. No reflow was observed in 31 patients (61%). Variables associated with no-reflow at univariate analysis included culprit lesion of the left anterior coronary descending artery (LAD) (67 vs. 29%, P=0.006) and ET-1 plasma levels (3.95±0.7 vs. 3.3±0.8 pg/mL, P=0.004). At multivariable logistic regression analysis, ET-1 was the only significant predictor of no-reflow (P=0.03) together with LAD as the culprit vessel (P=0.04). Conclusion: ET-1 plasma levels predict angiographic no-reflow after successful primary or rescue PCI. These findings suggest that ET-1 antagonists might be beneficial in the management of no-reflow.

Original languageEnglish
Pages (from-to)1793-1798
Number of pages6
JournalEuropean Heart Journal
Issue number15
Publication statusPublished - Aug 2006


  • Endothelin-1
  • Myocardial infarction
  • No-reflow
  • Percutaneous coronary intervention
  • Reperfusion

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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