Effect Of Inflammatory Factors On Prognosis Of Patients With ST-segment Elevatrion Acute Myocardial Infarction

ObjectiveTo study four kinds of inflammatory cytokines include IL-1β, IL-18, TNF-α, PIGF, explore its relationship with the development of coronary heart disease,evaluate the ability of inflammatory biomarkers to improve cardiovascular risk prediction in patients with ST-segment elevation acute myocardial infarction. Methods120 patients fallowing coronary angiogrphy were enrolled randomly from 2009.4~2010.3, ST-segment elevation acute myocardial infarction (STEMI) in 38 patients, who were undergoing primary PCI in 12hours; Stable angina (SA) in 42 patients; Normal coronary angiography (CONT) in 40 patients as control group. Blood samples were collected in the catheterization laboratory following vascular puncture. Plasma levels of IL-1β, IL-18, TNF-αand PIGF were measured by enzyme-linked immunosorbent assay (ELISA) in all patients. Then the patients with STEMI were followe-up with median time of 11 months (range 1-18 months). During 11months follow-up we observe the occurrence of primary cardiac events (cardiovascular death, non-fatal myocardial infarction, heart failure readmission) and secondary cardiac events (unstable angina pain,percutaneous coronary intervention, coronary artery bypass graft), and assessed their association with risk of primary cardiac events and secondary cardiac events over 11 months of follow-up.Result1. Compared with the SA patients and control subjects, patients with STEMI exhibited higher levels of IL-1β(p<0.05), IL-18(p<0.05), TNF-α(p<0.05) PIGF(p<0.05).2. In the STEMI patients,IL-1β(p<0.05), IL-18(p<0.05), TNF-α(p<0.05),PIGF(p<0.05) was elevated in patients who occured primary cardiac events compared with no-MACE patients during in-hospital.3. Logistic regression analysis revealed that IL-18, IL-1β, TNF-αsignificantly and independently correlated with the occurrence of MACE during in-hospital.4. In a forward Cox regression procedure that included traditional risk factors, IL-1β(hazard ratio [HR] 4.495,95% CI 1.568to 6.246; P=0.011), TNF-α(hazard ratio [HR] 3.042,95% CI 1.356 to 6.243; P=0.018)was significantly related to the primary outcome during a 11-months follow-up in patients with STEMI.Conclusion1. The present study indicates that elevated admission level of IL-1β, IL-18, TNF-α, PIGF might indicate the onset of STEMI.2. In patients with STEMI, plasma IL-18, IL-1β, TNF-αlevel is a major independent inflammatory predictor of in-hospital MACE.3. Evaluation of circulating IL-18, IL-1β,TNF-αmight improve the prediction of adverse clinical outcomes following STEMI at 11-months follow-up. Plasma concentrations of IL-1β,TNF-αis a major independent inflammatory predictor of the occurrence of primary cardiac events within 11 months in patients with STEMI.4. PIGF is risk factor for MACE in patients with STEMI during in-hospital, and improve predictive value of the occurrence of future MACE in patients with STEMI.