Association Between Acute Inflammatory Response and Infarct Size in Stemi Patients Undergoing Primary PCI

Abstract

Background: The inflammatory response of the immune system plays a major role in the period following an acute myocardial infarction (MI), as it coordinates the formation of the fibrous scar tissue that replaces the infarcted myocardial cells and ultimately leads to healing and remodeling of the affected zone. Along with other pro- and anti-inflammatory cytokines and acute phase proteins, interleukin-6 (IL-6) and C-reactive protein (CRP) are associated with the extent of the infarct size (IS) and may serve as predictors for remodeling and adverse left ventricular (LV) function. Material and methods: A single-center, non-randomized, observational prospective study was conducted, which included 75 patients with primary revascularized ST-elevation myocardial infarction (STEMI). High-sensitivity CRP (hs-CRP) serum levels were determined on day 1 and day 5 following the acute event. IL-6 was also determined on day 1. All patients underwent cardiac magnetic resonance imaging (CMR) at 1-month follow-up with determination of LV function and quantification of the scar tissue using late gadolinium enhancement imaging. The patients were divided into 2 groups based on baseline hs-CRP values. Results: Patients with higher baseline hs-CRP levels presented significantly higher infarct size (p = 0.0003), higher transmural extent (p <0.0001), lower LV ejection fraction (p = 0.0024), end-systolic (p = 0.0021) and end-diastolic (p = 0.0065) volumes. Small IS (<10%) recorded the lowest levels of hs-CRP, while IS >20% presented the highest levels of hs-CRP, at baseline and day 5 (p = 0.4 and 0.001). IL-6 levels were also associated with the magnitude of infarct scar: 2.17 pg/mL for IS <10%, 15.52 pg/mL for IS between 10% and 20%, and 24.52 pg/mL for IS >20%, p = 0.002. Conclusion: hs-CRP and IL-6 serum levels following an MI are correlated with IS, transmurality extent of the scar tissue, as well as with altered systolic and diastolic LV function determined by CMR at 1-month follow-up.

Altered nutritional status, inflammation and systemic vulnerability in patients with acute myocardial infarction undergoing percutaneous coronary revascularisation: A prospective study in a level 3 cardiac critical care unit

“…The pro‐inflammatory phase occurs in the first 3 days after the infarction, is characterised by higher levels of circulating pro‐inflammatory cytokines and acute phase proteins such as IL‐6 and CRP and is associated with the immediate complications occurring early after the acute coronary event. The pro‐reparatory phase starts after 1–2 days and is responsible for cell accumulation at the site of the infarcted tissue in order to repair the damaged myocardium …”

“…The pro-reparatory phase starts after 1-2 days and is responsible for cell accumulation at the site of the infarcted tissue in order to repair the damaged myocardium. 19,20 Malnutrition has emerged as another important player in this equation of inflammation-atherosclerosis interaction and may represent a risk factor and/or prognostic indicator of cardiac outcomes. 13 Another study showed that, in STEMI patients, the long-term risk of all-cause death was higher in patients with malnutrition, expressed by a CONUT score <3.…”

A Promising Innovative Treatment for ST-Elevation Myocardial Infarction: The Use of C-Reactive Protein Selective Apheresis: Case Report

“…DOI: 10.1159/000506176 senting with ST-elevation myocardial infarction (STEMI) is well known. In patients with STEMI treated with primary percutaneous coronary intervention (PCI), higher baseline CRP levels are associated with larger infarct size, transmural extent, and poor systolic and diastolic function of left ventricle (LV) and independently predicted 30-day mortality [2][3][4]. CRP-apheresis following STEMI is feasible, safe, and results presented from a small cohort showed significant beneficial effects of CRP both on myocardial infarction size and wall motion [4].…”

“…CRP-apheresis following STEMI is feasible, safe, and results presented from a small cohort showed significant beneficial effects of CRP both on myocardial infarction size and wall motion [4]. Therefore, CRP reduction from plasma brings selective CRP-apheresis as innovative therapeutic approach in the treatment of AMI [3,4].…”

Inflammation in Acute Cardiac Care

“…The results of the study by Morariu et al show us how the inflammatory reactions in acute settings can impact the cardiac status on a medium and potentially long term, providing an explanation for the findings we commonly see at the routine, image-based follow-up of patients suffering an acute cardiac event. 17…”