Different inflammatory profile in young and elderly STEMI patients undergoing primary percutaneous coronary
Serena Del Turco1, Giuseppina Basta1, Alberto Ranieri De Caterina2
1CNR, Institute of Clinical Physiology, Via G. Moruzzi, 1, 56124 Pisa, Italy.
Insights
Elderly patients with ST-segment elevation myocardial infarction (STEMI) exhibit a heightened inflammatory response, increasing risks of no-reflow and mortality. Age-specific inflammatory markers predict outcomes in STEMI patients undergoing primary percutaneous coronary intervention (pPCI).
Area of Science:
- Cardiology
- Inflammation Research
- Geriatric Medicine
Background:
- The no-reflow phenomenon in ST-segment elevation myocardial infarction (STEMI) is linked to poor prognosis.
- A deregulated systemic inflammatory response is implicated in STEMI pathophysiology.
- The impact of age-related inflammatory marker differences on no-reflow and mortality in STEMI patients undergoing primary percutaneous coronary intervention (pPCI) remains uninvestigated.
Purpose of the Study:
- To investigate the relationship between age-associated differences in inflammatory markers and the occurrence of no-reflow or mortality in STEMI patients undergoing pPCI.
- To compare inflammatory profiles and their association with outcomes between elderly and younger STEMI patients.
Main Methods:
- Retrospective analysis of 625 STEMI patients undergoing pPCI with available laboratory inflammatory patterns.
- Blood parameters measured on admission; no-reflow defined as Thrombolysis in Myocardial Infarction (TIMI) flow-grade < 3.
- Patients divided into two groups: ≤65 years (young) and >65 years (elderly).
Main Results:
- Elderly patients showed higher mean levels of fibrinogen, brain natriuretic peptide (BNP), leukocytes, neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein/albumin ratio (CAR).
- Younger patients had higher lymphocyte counts and albumin levels.
- In elderly patients, NLR, CAR, leukocytes, fibrinogen, and neutrophils were associated with no-reflow; in young patients, only BNP was associated.
- BNP and NLR independently predicted all-cause mortality in the overall population and in elderly patients.
Conclusions:
- Elderly STEMI patients present with a more acute pro-inflammatory profile upon admission, correlating with increased risks of coronary no-reflow and mortality.
- These findings suggest that age-specific therapeutic strategies may be warranted for STEMI patients.
Background:
Coronary no-reflow phenomenon in ST-segment elevation myocardial infarction (STEMI) is associated with a poor clinical prognosis. Although its pathophysiology is not fully elucidated, a deregulated systemic inflammatory response plays an important role. Specifically, the relationship between age-associated differences in inflammatory markers and either no-reflow or mortality in STEMI patients undergoing primary percutaneous coronary intervention (pPCI) has never been investigated.
Methods And Results:
We retrospectively enrolled 625 consecutive STEMI patients undergoing pPCI for whom a complete laboratory inflammatory pattern was available. Routinely blood measured laboratory parameters were collected at the moment of admission. No reflow was defined as Thrombolysis in Myocardial Infarction (TIMI) flow-grade lower than 3. The population was divided into two groups using a cut-off centered at 65 years. Compared to younger patients, elderly patients had higher mean values of fibrinogen, brain natriuretic peptide (BNP), leukocytes, neutrophil-to-lymphocyte ratio (NLR), C reactive protein/albumin ratio (CAR). Conversely, lymphocyte count and albumin levels were higher in young patients. In elderly patients, the values of NLR, CAR as well as leukocytes, fibrinogen and neutrophils were associated with no-reflow, while in young patients only BNP value was associated. At multivariate Cox regression analysis, only BNP and NLR resulted as independent predictors of all-cause mortality in the whole population and in elderly patients.
Conclusions:
Elderly STEMI patients on admission had a higher acute pro-inflammatory profile than young patients, associated to coronary no-reflow and mortality outcome. These results suggest that a different therapeutic approach between elderly and young STEMI patients should be agreed.
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