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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Admission macrophage migration inhibitory factor predicts long-term prognosis in patients with ST-elevation
Xiang-Ning Deng1,2,3,4, Xin-Yu Wang1,2,3,4, Hai-Yi Yu1,2,3,4
1Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, 49 Hua Yuan Bei Lu, Hai Dian District, Beijing, China.
Aims:
We previously showed in patients with ST-segment elevated myocardial infarction (STEMI) that admission levels of macrophage migration inhibitory factor (MIF) predict infarct size. We studied whether admission MIF alone or in combination with other biomarkers is useful for risk assessment of acute and chronic clinical outcomes in STEMI patients.
Methods And Results:
A total of 658 STEMI patients treated with primary percutaneous coronary intervention (PCI) were consecutively recruited. MIF level was determined at admission and echocardiography performed on day-3 and then 12 months post-MI. Patients were followed for a median period of 64 months. Major endpoints included ST-segment resolution, all-cause mortality, and major adverse cardiovascular events (MACE). High MIF level was associated with larger enzymatic infarct size, incomplete resolution of ST-segment elevation post-PCI, impaired left ventricular ejection fraction (LVEF), and poorer improvement of LVEF (all P < 0.001). After adjustment for classical risk factors standard biomarkers and day-3 LVEF, admission MIF remained independently prognostic for all-cause mortality [hazard ratio (HR) 2.27, 95% confidence interval (CI) 1.43-3.22], and MACE (HR 1.39, 95% CI 1.12-1.71, both P < 0.05). MIF was a significant additive predictor of all-cause mortality with a net reclassification improvement of 0.34 (P = 0.02). Furthermore, patients in high tertile of both admission MIF and day-3 Nt-proBNP had the highest mortality risk relative to other tertile groups (HR 11.28, 95% CI 4.82-26.94; P < 0.001).
Conclusion:
STEMI patients with high admission MIF level experienced a poorer recovery of cardiac function and worse long-term adverse outcomes. Combination of Nt-proBNP with MIF further improves prognostic capability.
Insights
High admission levels of macrophage migration inhibitory factor (MIF) in ST-segment elevated myocardial infarction (STEMI) patients predict poorer cardiac function and worse long-term outcomes. Combining MIF with Nt-proBNP enhances risk prediction for mortality.
Area of Science:
- Cardiology
- Biomarker Research
- Clinical Outcomes
Background:
- Macrophage migration inhibitory factor (MIF) levels at admission predict infarct size in ST-segment elevated myocardial infarction (STEMI) patients.
- Further investigation is needed to assess MIF's role in predicting acute and chronic clinical outcomes in STEMI.
Purpose of the Study:
- To evaluate the utility of admission MIF levels, alone and in combination with other biomarkers, for risk assessment in STEMI patients.
- To determine the prognostic value of MIF for acute and long-term clinical outcomes following STEMI.
Main Methods:
- A cohort of 658 STEMI patients treated with primary percutaneous coronary intervention (PCI) was studied.
- Admission MIF levels, day-3 and 12-month echocardiography, and long-term follow-up (median 64 months) were assessed.
- Endpoints included ST-segment resolution, all-cause mortality, and major adverse cardiovascular events (MACE).
Main Results:
- High admission MIF was associated with larger infarct size, incomplete ST-segment resolution, and impaired left ventricular ejection fraction (LVEF).
- Admission MIF independently predicted all-cause mortality and MACE after adjusting for classical risk factors and day-3 LVEF.
- MIF was an additive predictor of mortality, and its combination with day-3 Nt-proBNP significantly identified patients at highest mortality risk.
Conclusions:
- Elevated admission MIF in STEMI patients correlates with poorer cardiac function recovery and worse long-term adverse outcomes.
- Admission MIF is an independent prognostic marker for mortality and MACE in STEMI.
- Combining MIF with Nt-proBNP improves the prognostic capability for adverse outcomes in STEMI.
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