Elevated plasma asymmetric dimethylarginine level in acute myocardial infarction patients as a predictor of poor prognosis and angiographic impaired reperfusion

Objectives: We aimed to investigate the effects of admission asymmetric dimethylarginine (ADMA) levels on myocardial perfusion and prognosis in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). Background: ADMA, an endogenous inhibitor of endothelial nitric oxide synthase, was found to be elevated in plasma of patients with cardiovascular risk factors. Methods: 168 consecutive patients undergoing primary PCI for STEMI <12 h after symptom onset and 75 healthy age and sex matched volunteer controls were enrolled in the study. Patients with STEMI were grouped into tertiles according to their admission plasma ADMA levels. Major adverse cardiac events during hospitalization or at one-year clinical follow-up were evaluated. Also angiographic impaired reperfusion was assessed by 3 different methods after PCI: angiographic thrombolysis in myocardial infarction (TIMI) flow, TIMI frame count and TIMI myocardial perfusion grade (TMPG). Results: Plasma level of l-arginine were lower in patients with STEMI than in the control group subjects, whereas plasma ADMA levels were increased in the STEMI patient group. The rate of impaired angiographic reperfusion increased across the tertile groups. Also one-year mortality rates showed a significant increase across the tertile groups (4% vs. 10% vs. 20%, p < 0.01). Using multiple Cox regression analysis, only TIMI risk score, left ventricle ejection fraction (LVEF), abnormal TMPG, and increased ADMA values on admission emerged as independent predictors of one-year mortality. The ROC analysis indicated an optimal cut-point of >= 1.37 mu mol/L, which detects one-year mortality with a negative predictive value of 96%. Conclusions: In STEMI patients undergoing primary PCI, high admission ADMA levels were found to be associated with impaired myocardial perfusion and increased one-year mortality. Therefore admission ADMA level detection may be helpful in identifying the patients at a greater risk of impaired myocardial perfusion and poor prognosis. (C) 2011 Elsevier Ireland Ltd. All rights reserved.