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Early measurements of plasma matrix metalloproteinase-2 predict infarct size and ventricular dysfunction in ST-elevation myocardial infarction
  1. Lennart Nilsson1,2,
  2. Jonas Hallén3,4,
  3. Dan Atar3,4,
  4. Lena Jonasson1,2,
  5. Eva Swahn1,2
  1. 1Division of Cardiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
  2. 2Department of Cardiology, University Hospital, Linköping, Sweden
  3. 3Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
  4. 4Institute for Clinical medicine, University of Oslo, Oslo, Norway
  1. Correspondence to Dr Lennart Nilsson, Department of Cardiology, University Hospital, Linköping S-58185, Sweden; lennart.nilsson{at}liu.se

Abstract

Background Immediate reopening of the acutely occluded infarct-related artery via primary PCI is the preferred treatment in ST-elevation myocardial infarction (STEMI). However, the sudden reinitiation of blood flow can lead to a local acute inflammatory response with further endothelial and myocardial damage, so-called reperfusion injury. The activation of matrix metalloproteinases (MMPs) is suggested to be a key event in this process.

Objectives To investigate circulating MMPs, tissue inhibitors of metalloproteinases (TIMPs) and myeloperoxidase (MPO) in relation to infarct size, left ventricular dysfunction and remodelling in a STEMI population undergoing PCI.

Methods 58 Patients with STEMI undergoing primary PCI were included. Blood samples were collected at baseline before PCI and at 12, 24 and 48 h for later analysis of MMPs, TIMPs and MPO by ELISA. Infarct size, left ventricular (LV) dysfunction and remodelling were assessed by cardiac MRI at 5 days and 4 month after STEMI.

Results Plasma MMP-2 at 0 and 12 h showed a consistent and significant correlation with infarct size and LV dysfunction measured both at 5 days and at 4 months and correlated well with troponin I measurements. For TIMP-1 and TIMP-2 some support was found for associations with infarct size and LV dysfunction, but these were not as consistent as for MMP-2. MMP-8, MMP-9 and MPO did not overall correlate with measures of infarct size, LV dysfunction or remodelling.

Conclusions In patients with STEMI, circulating levels of MMP-2, measured early and even before reperfusion therapy, are strongly associated with infarct size and LV dysfunction. This provides further evidence for the role of MMP-2 in ischaemia-reperfusion injury.

  • Matrix metalloproteinase
  • ST-elevation myocardial infarction
  • ischaemia-reperfusion injury
  • coronary artery disease
  • myocardial ischaemia and infarction (IHD)
  • acute coronary syndrome
  • risk stratification
  • risk factors
  • st-t changes
  • STEMI

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Footnotes

  • See Editorial, p 1

  • Funding This project was supported by grants from the Swedish Heart-Lung foundation and the Foundation for Old Servants.

  • Competing interests None to declare.

  • Patient consent Obtained.

  • Ethics approval The study protocol was approved by all local ethic committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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