The Chymase/Angiotensin-2 Local Renin-Angiotensin System Pathway Exists and Works Independently in Cardiac Ventricular Remodeling in Patients with Acute STEMI after PCI and Reperfusion

Abstract

Objective: To examine the expression of plasma chymase and angiotensin-2 (Ang-2) in patients with acute ST-elevation myocardial infarction (STEMI) and to observe the influence of percutaneous coronary intervention (PCI) and reperfusion on the levels of these factors. Furthermore, we aim to evaluate the correlation of chymase and Ang-2 with cardiac ventricular remodeling after ischemia/reperfusion. Methods: We retrospectively analyzed the data of 120 STEMI patients who underwent primary PCI within 2 h after admission, and were categorized into three groups according to the target vessel. Plasma expressions of chymase, angiotensin-converting enzyme 2 (ACE2), and Ang-1/2 were detected at different time points through enzyme-linked immunosorbent assay (ELISA). Left ventricular ejection fraction (LVEF) and left ventricular end-diastolic volume (LVEDV) were subsequently determined through echocardiography, as indices of cardiac ventricular remodeling. Lastly, statistical analyses were conducted to differentiate the correlations. Results: Plasma chymase, ACE2, Ang-1, and Ang-2 levels in the left anterior descending artery (LAD) group were significantly higher than those in the left circumflex and right coronary artery groups before PCI (p < 0.01). The plasma expression levels of chymase, ACE2, and Ang-1/2 were reduced immediately with PCI. However, the levels in the LAD group were still the highest among all three groups. The four plasma neuroendocrine factors continued to be elevated on day 7 after PCI. Furthermore, logistic regression analysis confirmed that plasma chymase and Ang-2 were highly correlated with decreasing LVEF and enlarging LVEDV on day 7 after PCI. Conclusions: The present study showed that plasma chymase, ACE2, and Ang-2 levels were elevated in patients with STEMI, especially in the LAD group. Primary PCI led to rapid decreases in plasma chymase, ACE2, Ang-1, and Ang-2 levels.