Correlation between serum vitamin D level and coronary thrombus burden , TIMI flow and myocardial blush in patient with acute ST segment elevation myocardial infarction

Abstract

Despite the medical and technological improvements in the re-vascularization procedures in coronary artery diseases (CAD), ST-segment elevation myocardial infarction (STEMI) remains a significant health concern. Primary percutaneous coronary intervention (PCI) is the favorable treatment option for restoring perfusion to the affected area of the myocardium as soon as possible. In STEMI, the incidence of no-reflow has been reported to be ranging between 11 and 41%, depending on several clinical and angiographic factors in addition to the adopted definition of no-reflow. The pathogenesis of no-reflow is known to be multi-factorial, and its possible mechanisms include injury-related to ischemia, reperfusion, endothelial dysfunction, microvascular spasm, and distal thromboembolism. Vitamin D deficiency causes endothelial dysfunction through its direct or indirect effect through the up-regulation of the renin-angiotensin system or via induction of smooth muscle proliferation and a pro-inflammatory state. Prevalence of vitamin D deficiency was estimated to be approximately 30–50% of the general population and, several studies have shown an association between vitamin D deficiency and cardiovascular diseases (CVD) including, hypertension (HTN), acute myocardial infarction (AMI), heart failure, CAD, metabolic syndrome, and diabetes mellitus (DM). This study aimed to evaluate serum vitamin D levels relationship with coronary thrombus grade, Thrombolysis In Myocardial Infarction (TIMI) flow, and myocardial blush grade (MBG) in patients with first acute STEMI undergoing primary PCI. This was a prospective cohort study that included 80 patients with their first acute STEMI who presented to Ain Shams University hospitals within 12 hours after the onset of chest pain and referred for primary PCI in the period between December 2017 and November 2018. Inclusion criteria: patients with their first acute STEMI who presented within 12 hours after the onset of chest pain and referred for primary PCI in Ain Shams University hospital catheterization laboratory were enrolled in the study.