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Galectin-3, a new proof of the better outcome of deferred stenting in STEMI patients with high thrombus burden


Journal of Cardiology & Current Research
Mohammad Gouda, Baher Nabil, Marwa Mohammad Gad

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Abstract

Background: The issue of inevitable microvascular blockade after PPCI, especially if high thrombus burden, raise the idea of deferred stenting “DS”. DS refers to the concept of a minimalist immediate mechanical intervention (MIMI) using the simple guide wire or a very small balloon in an emergency to reopen an infarct-related artery in acute STEMI, and to postpone stenting to the following days in stable conditions. Remodeling and myocardial fibrosis are inevitable with subsequent progression to heart failure (HF) if we fail to protect the microvasculature in STEMI. Macrophages secrete Galectin-3, which stimulate additional macrophages, pericytes, myofibroblasts, and fibroblasts and subsequent cellular proliferation and secretion of procollagen I. Methods: We recruited consecutive 116 STEMI cases with high thrombus burden (grades 4–5). Admission Galectin-3 assessment. Precise timing of onset of chest Pain until Wiring of the blocked artery (PWT). Echocardiography assessment was done during preparation of PPCI, measures of LV systolic function (EF by modified Simpson method and Left Ventricular End Systolic Volume Index “LVESVI”). All cases were prepared with the same antiplatelet, anticoagulant and statin therapies then PPCI was performed as soon as possible, decision to immediate stenting or just wiring to achieve TIMI-3 flow, keep on medical therapy and stent after 48 hours (deferred stenting), was the operator choice. Follow up of the cases for the following 3 months and then the same echocardiographic measures as well as measuring the level of Galectin-3 was repeated. We classified the patients into Group I (Immediate stenting, 78 cases) and Group II (Deferred stenting, 38 cases). Results: After 3 months of follow up, there was a highly significant difference between both groups concerning EF, LVESVI and Galectin-3. EF decreased to 44.18±11.32 % in group I while it jumps to 52.89±7.32% in-group II (t=3.05, p<0.001). LVESVI; it increased to 44.77±11.84 ml3/m2 in-group I while in-group II it decreased to 33.26±6.27ml3/m2 (t=- 3.96, p<0.001). Galactin-3, it was 21.67±6.48 ng/ml in-group I while it was 15.71±3.80 ng/ mL in-group II (t=-3.70, p<0.001). The EF after 3 months has a highly significant negative correlation with the level of Galectin-3 after 3 months of follow up (r=-0.82, p<0.001) while it has no significant correlation with the level of admission Galactin-3. LVESVI after 3 months has a highly significant positive correlation with the level of Galaectin-3 after 3 months (r=0.89, p<0.001) while it has no significant correlation with level of admission Galactin-3. The regression analysis confirmed that level of Galactin-3 after 3 months is a strong predictor of recovery of both LVESVI and EF (t=8.13, p<0.001), (t=-5.28, p<0.001). Conclusion: Admission Galectin-3 level cannot predict the recovery of LV function after PPCI while Galectin-3 after 3 months can do. DS is recommended in STEMI cases with
high thrombus burden.

Keywords

Primary PCI, Deferred stenting, Remodeling, Galectin-3

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