High cholesterol in patients with ECG signs of no-reflow after myocardial infarction.

PURPOSE Despite successful restoration of blood flow in epicardial artery after myocardial infarction (MI), some patients do not benefit sufficiently from modern revascularisation methods due to the impairment of microcirculation, also called no-reflow phenomenon. Hyperlipidaemia is well established risk factor of coronary heart disease and its detrimental actions on vessels are widely acknowledged. We attempted to investigate possible relations between hyperlipidaemia and electrocardiographic signs of no-reflow in myocardial infarction after successful primary angioplasty. MATERIAL AND METHODS A total of 150 consecutive patients with acute myocardial infarction (AMI) with ST elevation who underwent successful primary angioplasty were studied. ECG was obtained directly before and 30 minutes after successful reperfusion. ST segment deviation was measured. Lack of 50% reduction of ST-segment elevation in the lead with maximal initial elevation, 30 minutes after angioplasty was defined as ECG sign of no-reflow. RESULTS ST-segment resolution occurred in 116 patients (77%), whereas 34 presented ECG signs of no-reflow (23%). Patients with persistent ST-segment elevation had higher blood LDL and total cholesterol (TC) levels than group with ST-segment restoration (146.5 vs. 128.7 p < 0.01 and 219.5 vs. 200.9, p < 0.05 respectively). Triglyceride, HDL, glucose on admission and fasting glucose levels did not differ significantly between groups. ECG signs of no-reflow were observed more often in patients with anterior AMI, history of prior myocardial infarction and longer pain-to-balloon time (p < 0.05). CONCLUSIONS Positive relation between impaired tissue perfusion and high TC and LDL blood levels suggests that lipids may play a role in the pathogenesis of no-reflow phenomenon, possibly by impairment of endothelial function.