EURO PEAN SO CIETY O F CARDIOLOGY ®
Original scientific paper
Hypotestosteronemia is frequent in ST-elevation myocardial infarction patients and is associated with coronary microvascular obstruction
European Journal of Preventive Cardiology 2015, Vol. 22(7) 855–863 ! The European Society of Cardiology 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/2047487314533084 ejpc.sagepub.com
Giampaolo Niccoli1, Domenico Milardi2, Domenico D’Amario1, Francesco Fracassi1, Giuseppe Grande2, Roberta Antonazzo Panico1, Marco Roberto1, Alessandro Mandurino Mirizzi1, Giulia Canu3, Laura De Marinis2, Cinzia Carrozza3, Alfredo Pontecorvi2 and Filippo Crea1
Abstract Background: Gonadal function is thought to be involved in existing atherosclerotic plaques stabilization and might affect reperfusion after primary percutaneous coronary intervention (pPCI). We aimed to compare the prevalence of hypotestosteromenia between ST-elevation myocardial infarction (STEMI) and stable angina (SA) patients and between patients with and without microvascular obstruction (MVO). Design: Cross-sectional observational study. Methods: Males with STEMI (n ¼ 70, age 57.1 7.8 years) or with stable angina (n ¼ 30, age 59.9 8.4 years) were enrolled. Angiographic MVO (angio-MVO) was defined as final TIMI flow 2 or final TIMI flow 3 with MBG 2 while electrocardiographic MVO (ECG-MVO) as a ST-segment resolution 3 mg/dl), contraindications to contrast agents, or other study medications, paced rhythm, frequent ventricular ectopy, left bundle branch block, pre-excitation or other conditions or artifacts interfering with interpretation of ST-segment, rescue PCI, culprit lesion located in a bypass graft, stent thrombosis, culprit lesion non-identified, left main disease and cardiogenic shock. Moreover, we excluded patients over 75 years, in order to minimize age-related hypotestosteronemia.14 Based on these exclusion criteria, 18 patients were eventually excluded from the study, because of rescue PCI (n ¼ 9), late presentation (>12 hours) (n ¼ 7), stent thrombosis (n ¼ 2). All patients were treated with aspirin (300 mg) and clopidogrel (600 mg) on admission in the emergency room. All pPCIs were performed through a radial or femoral access according to operator preference, using a 6 French catheter. A bolus of 5000 IU of heparin was administrated. Manual thrombus aspiration and glycoprotein IIb/IIIa inhibitors after diagnostic angiogram at the starting of pPCI (intravenous bolus administration of abciximab, 0.25 mg/kg with a 12-hour infusion following the bolus) were used in all patients. Angiography and ST-segment elevation resolution (STR) at 90 minutes were used respectively to evaluate angiographic MVO (angio-MVO) and ECGMVO occurrence. The criteria for defining both angioMVO and ECG-MVO occurrence is reported below. In all patients cardiovascular risk factors were carefully examined, including family history of early CAD
Downloaded from cpr.sagepub.com by guest on November 15, 2015
Niccoli et al.
857
(first degree relative with a history of myocardial infarction 130 mg/dl, high density lipoprotein 150 mg/dl, or total cholesterol >200 mg/dl), smoking habit and hypertension (systolic blood pressure >140 mmHg and/or diastolic blood pressure >90 mmHg or treated hypertension). Time to pPCI was also recorded, as well as therapy on admission and body mass index (BMI). The study was approved by the local Ethics Committee and after a complete explanation of the aims and details of the study, all patients gave their informed written consent before entering the study.
physiological T range for healthy men in our laboratory, in accordance with The Endocrinology Society clinical practice guidelines on T therapy in men with androgen deficiency syndrome. LH and FSH were assayed by immunoradiometric methods on a solidphase (coated tube) based on a monoclonal doubleantibody technique. INSL-3 was evaluated in duplicate by RIA (Phoenix Pharmaceuticals). The lower detection limit of this assy was 1 pg/tube (10 pg/ml) and the range of this assay was 1–128 pg/tube (10–1280 pg/ml). Hypotestosteronemia was defined as T < 2.50 ng/ml with INSL-3 < 305.5 pg/ml, as previously described by Foresta et al.12
Statistical analysis Coronary angiographic analysis Angiographic assessment was performed by two independent angiographers (GN and DD) who were unaware of the patients’ characteristics; the final agreement was of 95% (discordances were resolved by consensus). TIMI flow and myocardial blush grade (MBG) were assessed according to previous studies.15,16 Angio-MVO was defined as a final TIMI flow 2 or final TIMI flow 3 with an MBG
Original scientific paper
Hypotestosteronemia is frequent in ST-elevation myocardial infarction patients and is associated with coronary microvascular obstruction
European Journal of Preventive Cardiology 2015, Vol. 22(7) 855–863 ! The European Society of Cardiology 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/2047487314533084 ejpc.sagepub.com
Giampaolo Niccoli1, Domenico Milardi2, Domenico D’Amario1, Francesco Fracassi1, Giuseppe Grande2, Roberta Antonazzo Panico1, Marco Roberto1, Alessandro Mandurino Mirizzi1, Giulia Canu3, Laura De Marinis2, Cinzia Carrozza3, Alfredo Pontecorvi2 and Filippo Crea1
Abstract Background: Gonadal function is thought to be involved in existing atherosclerotic plaques stabilization and might affect reperfusion after primary percutaneous coronary intervention (pPCI). We aimed to compare the prevalence of hypotestosteromenia between ST-elevation myocardial infarction (STEMI) and stable angina (SA) patients and between patients with and without microvascular obstruction (MVO). Design: Cross-sectional observational study. Methods: Males with STEMI (n ¼ 70, age 57.1 7.8 years) or with stable angina (n ¼ 30, age 59.9 8.4 years) were enrolled. Angiographic MVO (angio-MVO) was defined as final TIMI flow 2 or final TIMI flow 3 with MBG 2 while electrocardiographic MVO (ECG-MVO) as a ST-segment resolution 3 mg/dl), contraindications to contrast agents, or other study medications, paced rhythm, frequent ventricular ectopy, left bundle branch block, pre-excitation or other conditions or artifacts interfering with interpretation of ST-segment, rescue PCI, culprit lesion located in a bypass graft, stent thrombosis, culprit lesion non-identified, left main disease and cardiogenic shock. Moreover, we excluded patients over 75 years, in order to minimize age-related hypotestosteronemia.14 Based on these exclusion criteria, 18 patients were eventually excluded from the study, because of rescue PCI (n ¼ 9), late presentation (>12 hours) (n ¼ 7), stent thrombosis (n ¼ 2). All patients were treated with aspirin (300 mg) and clopidogrel (600 mg) on admission in the emergency room. All pPCIs were performed through a radial or femoral access according to operator preference, using a 6 French catheter. A bolus of 5000 IU of heparin was administrated. Manual thrombus aspiration and glycoprotein IIb/IIIa inhibitors after diagnostic angiogram at the starting of pPCI (intravenous bolus administration of abciximab, 0.25 mg/kg with a 12-hour infusion following the bolus) were used in all patients. Angiography and ST-segment elevation resolution (STR) at 90 minutes were used respectively to evaluate angiographic MVO (angio-MVO) and ECGMVO occurrence. The criteria for defining both angioMVO and ECG-MVO occurrence is reported below. In all patients cardiovascular risk factors were carefully examined, including family history of early CAD
Downloaded from cpr.sagepub.com by guest on November 15, 2015
Niccoli et al.
857
(first degree relative with a history of myocardial infarction 130 mg/dl, high density lipoprotein 150 mg/dl, or total cholesterol >200 mg/dl), smoking habit and hypertension (systolic blood pressure >140 mmHg and/or diastolic blood pressure >90 mmHg or treated hypertension). Time to pPCI was also recorded, as well as therapy on admission and body mass index (BMI). The study was approved by the local Ethics Committee and after a complete explanation of the aims and details of the study, all patients gave their informed written consent before entering the study.
physiological T range for healthy men in our laboratory, in accordance with The Endocrinology Society clinical practice guidelines on T therapy in men with androgen deficiency syndrome. LH and FSH were assayed by immunoradiometric methods on a solidphase (coated tube) based on a monoclonal doubleantibody technique. INSL-3 was evaluated in duplicate by RIA (Phoenix Pharmaceuticals). The lower detection limit of this assy was 1 pg/tube (10 pg/ml) and the range of this assay was 1–128 pg/tube (10–1280 pg/ml). Hypotestosteronemia was defined as T < 2.50 ng/ml with INSL-3 < 305.5 pg/ml, as previously described by Foresta et al.12
Statistical analysis Coronary angiographic analysis Angiographic assessment was performed by two independent angiographers (GN and DD) who were unaware of the patients’ characteristics; the final agreement was of 95% (discordances were resolved by consensus). TIMI flow and myocardial blush grade (MBG) were assessed according to previous studies.15,16 Angio-MVO was defined as a final TIMI flow 2 or final TIMI flow 3 with an MBG
