EpCAM and microvascular obstruction in patients with STEMI: a cardiac magnetic resonance study

Rev Esp Cardiol (Engl Ed). 2022 May;75(5):384-391. doi: 10.1016/j.rec.2021.04.006. Epub 2021 May 25.
[Article in English, Spanish]

Abstract

Introduction and objectives: Microvascular obstruction (MVO) is negatively associated with cardiac structure and worse prognosis after ST-segment elevation myocardial infarction (STEMI). Epithelial cell adhesion molecule (EpCAM), involved in epithelium adhesion, is an understudied area in the MVO setting. We aimed to determine whether EpCAM is associated with the appearance of cardiac magnetic resonance (CMR)-derived MVO and long-term systolic function in reperfused STEMI.

Methods: We prospectively included 106 patients with a first STEMI treated with percutaneous coronary intervention, quantifying serum levels of EpCAM 24hours postreperfusion. All patients underwent CMR imaging 1 week and 6 months post-STEMI. The independent correlation of EpCAM with MVO, systolic volume indices, and left ventricular ejection fraction was evaluated.

Results: The mean age of the sample was 59±13 years and 76% were male. Patients were dichotomized according to median EpCAM (4.48 pg/mL). At 1-week CMR, lower EpCAM was related to extensive MVO (P=.021) and larger infarct size (P=.019). At presentation, EpCAM values were significantly associated with the presence of MVO in univariate (OR, 0.58; 95%CI, 0.38-0.88; P=.011) and multivariate logistic regression models (OR, 0.55; 95%CI, 0.35-0.87; P=.010). Although MVO tends to resolve at chronic phases, decreased EpCAM was associated with worse systolic function: reduced left ventricular ejection fraction (P=.009) and higher left ventricular end-systolic volume (P=.043).

Conclusions: EpCAM is associated with the occurrence of CMR-derived MVO at acute phases and long-term adverse ventricular remodeling post-STEMI.

Keywords: Cardiac magnetic resonance; Epithelial cell adhesion molecule; Infarto agudo de miocardio con elevación del segmento ST; Microvascular obstruction; Obstrucción microvascular; Resonancia magnética cardiaca; ST-segment elevation myocardial infarction.

MeSH terms

  • Aged
  • Epithelial Cell Adhesion Molecule / metabolism*
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Magnetic Resonance Imaging, Cine
  • Magnetic Resonance Spectroscopy
  • Male
  • Microcirculation
  • Middle Aged
  • Percutaneous Coronary Intervention
  • ST Elevation Myocardial Infarction* / metabolism
  • ST Elevation Myocardial Infarction* / pathology
  • ST Elevation Myocardial Infarction* / surgery
  • Stroke Volume
  • Ventricular Function, Left

Substances

  • EPCAM protein, human
  • Epithelial Cell Adhesion Molecule