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Published on: January 28, 2020
Inflammatory biomarkers and long-term outcome in young patients three months after a first myocardial infarction
Sofia Cederström1, Tomas Jernberg1, Ann Samnegård1
1Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Sweden.
Insights
Interleukin-6 (IL-6) and Interleukin-18 (IL-18) are key biomarkers for predicting long-term cardiovascular outcomes in young myocardial infarction (MI) survivors. These inflammatory markers, assessed three months post-MI, offer crucial insights into future cardiac events.
Area of Science:
- Cardiology
- Immunology
- Biomarker Research
Background:
- Circulating inflammatory biomarkers after myocardial infarction (MI) often have limited predictive value due to acute-phase sampling and short follow-up.
- This study investigates the long-term predictive value of nine atherosclerosis-related inflammatory biomarkers in young MI patients.
Purpose of the Study:
- To compare the long-term predictive value of nine inflammatory biomarkers in young patients three months after a first-time MI.
- To identify key biomarkers for predicting cardiovascular outcomes over a 20-year follow-up period.
Main Methods:
- Nine inflammatory biomarkers were measured in 382 young (<60 years) patients three months after their first MI (1996-2000).
- Age- and sex-matched controls were included for comparison.
- Swedish national patient registers tracked cardiovascular outcomes for 20 years.
Main Results:
- Random forest models identified Interleukin-6 (IL-6) as the strongest predictor for the composite endpoint (death, heart failure, MI hospitalization) and for death and heart failure hospitalization separately.
- Interleukin-18 (IL-18) emerged as the most important predictor for MI hospitalization.
- Cox regression analysis confirmed that the highest tertile of IL-6 was significantly associated with increased risk of the composite endpoint, death, and heart failure hospitalization, even after adjusting for cardiovascular risk factors.
Conclusions:
- Interleukin-6 (IL-6) and Interleukin-18 (IL-18) are crucial biomarkers for predicting long-term cardiovascular outcomes in young myocardial infarction survivors.
- Assessing these inflammatory markers three months post-MI provides valuable prognostic information for up to 20 years.
Background:
Studies on predictive value of circulating inflammatory biomarkers after myocardial infarction (MI) have often been limited by blood sampling only in an acute setting and short follow-up time. We aimed to compare the long-term predictive value of nine inflammatory biomarkers, known to be involved in atherosclerosis, in young patients investigated three months after a first-time MI.
Methods:
Nine biomarkers (high-sensitivity C-reactive protein, interleukin (IL)-6, IL-18, monocyte chemoattractant protein-1, matrix metalloproteinase (MMP)-1, MMP-3, MMP-9, serum amyloid A and tumor necrosis factor-alfa) were sampled in 382 young (<60 years) patients and in age and sex-matched controls, three months after a first-time MI between 1996 and 2000. Swedish national patient registers were used to determine cardiovascular (CV) outcomes during 20 years of follow-up.
Results:
In cases, random forest models identified IL-6 as the most important predictor of the primary composite endpoint of death, heart failure (HF) or MI hospitalization, and the separate endpoints death and HF hospitalization. IL-18 was the most important predictor of MI hospitalization. In a Cox regression, the highest tertile of IL-6 was associated with the composite endpoint (HR (95% CI) 1.91 (1.31-2.79)), death (2.38 (1.42-3.98)) and HF hospitalization (2.70 (1.32-5.50)), when adjusting for age, sex and CV risk factors. The highest tertile of IL-18 was associated with MI hospitalization (2.31 (1.08-4.91)) when severity of coronary atherosclerosis was added to the same type of model.
Conclusions:
When nine inflammatory markers involved in atherosclerosis were analyzed three months after the acute event in young MI patients, IL-6 and IL-18 were the most important biomarkers to predict long-term CV outcomes during 20 years of follow-up.
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