0402: Angiopoietin-like 4 serum levels on admission for acute myocardial infarction are associated with no-reflow

BackgroundNo-reflow in ST-segment elevation acute myocardial infarction (STEMI) is associated with a poor clinical prognosis. Its pathophysiologal mechanisms are not totally elucidated yet but enhanced vascular permeability plays a key role in this process. ANGPTL4 has been implicated in vascular permeability in experimental models of AMI. We therefore sought to investigate whether baseline ANGPTL4 serum levels are associated with no-reflow after primary percutaneous coronary intervention (PPCI).MethodsA group of 41 consecutive patients with a first STEMI, undergoing successful PPCI within 12h of onset of symptoms were enrolled. Blood samples were obtained from all patients on admission for ANGPTL4 levels measurement. No-reflow was assessed by cardiac magnetic resonance imaging (MRI), the reference method.ResultsMRI-detected no-reflow was observed in 20 patients (48.8%). Variables independently associated with no-reflow at multivariate logistic regression analysis were: lower ANGPTL4 plasma levels (odds ratio 0.82, 95% CI 0.70-0.98, P=0.02), higher troponin T peak (odds ratio 1.03, 95% CI 1.00-1.05, P=0.03), higher incidence of left anterior descending coronary artery (LAD) as culprit artery (odds ratio 14.61, 95% CI 1.24-172.49, P=0.03), and higher C-reactive protein levels (odds ratio 1.18, 95% CI 1.00-1.39, P=0.05).ConclusionANGPTL4 serum levels predict MRI-detected no-reflow after successful PPCI in STEMI patients. Given the recently demonstrated therapeutic role of ANGPTL4 in diminishing no-reflow and therefore infarct size in pre-clinical animal models, these findings in humans may open new fields of research