European Heart Journal Advance Access published online on July 10, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn325
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Plasma levels of thromboxane A2 on admission are associated with no-reflow after primary percutaneous coronary intervention
1 Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, 00168 Rome, Italy
2 Department of Experimental Medicine, University ‘La Sapienza’, Rome, Italy
Received 28 November 2007; revised 27 May 2008; accepted 19 June 2008.
* Corresponding author. Tel: +39 06 301 54187, Fax: +39 06 305 5535, Email: gniccoli73{at}hotmail.it
See page 1795 for the editorial comment on this article (doi:10.1093/eurheartj/ehn281)
Aims: Thromboxane A2 (TXA2) is a key mediator of platelet activation and aggregation, and an important mediator of platelet-induced coronary artery constriction. We sought to investigate whether baseline plasma levels of TXA2 are associated with coronary no-reflow after primary percutaneous coronary intervention (PPCI).
Methods and results: A total of 47 consecutive patients (age, 62.5 ± 12.7; male sex, 76.6%) admitted to our hospital for a first ST-segment elevation myocardial infarction and undergoing PPCI within 12 h of onset of symptoms were enrolled. Admission TXA2 plasma levels were measured by enzyme-linked immunosorbent assay (ELISA). Angiographic no-reflow was defined as a final TIMI flow of 
2 or final TIMI flow of 3 with a myocardial blush grade of <2, whereas ST-segment resolution from baseline value of 50% was used as ECG index of no-reflow. At multivariable analysis TXA2 plasma levels, endothelin-1 (ET-1) plasma levels, and left anterior descending coronary artery (LAD) as culprit vessel were significant predictors of angiographic no-reflow (P = 0.04), whereas TXA2 and ET-1 plasma levels were the only independent predictors of lack of ST-segment resolution (P = 0.013 and 0.04, respectively). Of note, TXA2 tertiles were independent predictors of both angiographic no-reflow and lack of ST-segment resolution (OR, 3.5; 95% CI, 1.1–11; P = 0.03 and OR, 3; 95% CI, 1.3–7; P = 0.01, respectively).
Conclusion: TXA2 is an independent indicator of no-reflow that occurs after PPCI. This observation may open new therapeutic opportunity in the setting of PPCI.
Key Words: Primary percutaneous coronary intervention • Acute myocardial infarction • No-reflow • Platelets • Thromboxane A2
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