Associations of systemic oxidative stress with functional outcomes after ST-segment elevation myocardial infarction

Marie-Sophie L Y de Koning; Lawien Al Ali; Arno R Bourgonje; Solmaz Assa; Andreas Pasch; Harry van Goor; Erik Lipsic; Pim van der Harst

doi:10.1016/j.ijcard.2023.131214

Associations of systemic oxidative stress with functional outcomes after ST-segment elevation myocardial infarction

Int J Cardiol. 2023 Nov 15:391:131214. doi: 10.1016/j.ijcard.2023.131214. Epub 2023 Jul 28.

Authors

Marie-Sophie L Y de Koning¹, Lawien Al Ali², Arno R Bourgonje³, Solmaz Assa², Andreas Pasch⁴, Harry van Goor⁵, Erik Lipsic², Pim van der Harst⁶

Affiliations

¹ University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands. Electronic address: m.s.l.y.de.koning@umcg.nl.
² University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands.
³ University of Groningen, University Medical Center Groningen, Department of Gastroenterology and Hepatology, Groningen, the Netherlands.
⁴ Institute for Physiology and Pathophysiology, Johannes Kepler University, Linz 4040, Austria; Lindenhofspital, Department of Nephrology, Bern 3011, Switzerland; Nierenpraxis Bern, Bern 3011, Switzerland.
⁵ University of Groningen, University Medical Center Groningen, Department of Pathology and Medical Biology, Groningen, the Netherlands.
⁶ University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands; Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands.

PMID: 37517783
DOI: 10.1016/j.ijcard.2023.131214

Abstract

Background: Ischemia-reperfusion is accompanied by oxidative stress. Serum free thiols (FTs; sulfhydryl groups) reliably reflect systemic oxidative stress. This study evaluates longitudinal changes in FTs and their associations with outcomes after ST-segment elevation myocardial infarction (STEMI).

Methods: FTs were detected in archived serum samples from 378 participants of a neutral randomized trial on metformin therapy after STEMI. FT levels were determined at presentation with STEMI and at 24 h, 2 weeks, 4 months and 1 year thereafter. Outcomes included infarct size and left ventricular ejection fraction (LVEF), both determined with cardiac magnetic resonance imaging after 4 months, and 5-year major adverse cardiovascular events (MACE).

Results: Serum FT concentrations at presentation and at 24 h were 356 ± 91 and 353 ± 76 μmol/L, respectively. The change in FTs between presentation and 24 h (ΔFTs) was associated with outcomes in age- and sex-adjusted analysis (per 100 μmol/L FT increase, β = -0.87 for infarct size, 95% confidence interval (CI): -1.75 to -0.001, P = 0.050; β = 1.31, 95% CI: 0.37 to 2.25 for LVEF, P = 0.007). Associations between ΔFTs and LVEF were markedly stronger in patients with Thrombolysis in Myocardial Infarction flow of 0 or 1 before percutaneous coronary intervention (PCI)(β = 2.73, 95% CI: 0.68 to 4.77, P = 0.009). Declining FTs during the first 24 h might be associated with higher incidence of 5-year MACE (P = 0.09).

Conclusions: Changes in oxidative stress early post-PCI may predict functional outcomes after STEMI. Our findings warrant validation in larger cohorts, and then may be used as rationale for development of thiol-targeted therapy in ischemic heart disease.

Keywords: Acute coronary syndrome; Free thiols; Major adverse cardiovascular events; Oxidative stress.