Impact of plasma renin activity on clinical outcomes and left ventricular remodeling in patients with ST-segment elevation myocardial infarction

Abstract

Aims: This study was designed to investigate the relationships between plasma renin activity (PRA) and clinical and functional outcomes in patients with ST-segment elevation myocardial infarction. Methods: Our study included 445 patients who underwent primary percutaneous coronary intervention (PPCI). C-reactive protein (CRP), brain natriuretic peptide, aldosterone (PAC), and PRA were measured immediately after PPCI, and the patients were equally divided into two groups according to the median PRA values. Left ventriculograms after PCI and at 14 days were used to evaluate left ventricular (LV) function. Main outcome measures were mortality, cardiogenic shock, infarct size estimated by peak creatine kinase (CK) values, neurohormonal activation, and changes in LV function. Results: The high-PRA patients demonstrated significantly larger infarct size and highly complicated shock. CRP and PAC were higher in the high-PRA patients than in the low-PRA patients (CRP, 2.23±3.24 vs. 3.35±4.30 mg/dL, p = 0.002; PAC, 6.02±4.56 vs. 10.03±12.2 ng/dL, p < 0.001). LV remodeling assessed by changes in LV end-diastolic volume index were more prominent in the high-PRA patients (2.5±16.9 mL/m2) than in the low-PRA patients (7.9±15.3 mL/m2, p = 0.005). Multiple stepwise regression analysis adjusted for time to admission, anterior infarct location, PAC, CRP, peak CK, and PRA showed that PRA and peak CK were positive determinants of LV remodeling. View this table: Independent predictorf for delta LVEDVI Conclusions: PRA may be an integrated biomarker of neurohormonal activation and inflammation. Higher PRA was a positive predictor of LV remodeling.