Evaluation of the relationship between inflammation and typical chest pain in ST-elevation myocardial infarction

Previous investigations have shown that the absence of typical breast symptoms is associated with unfavorable outcomes after an acute myocardial infarction (AMI). Delayed diagnosis and therapy could not explain these results, so other causes seem to be involved. Therefore, in the present analysis the association between inflammatory plasma proteins and typical chest pain symptoms in hospitalized patients with acute ST-elevation myocardial infarction (STEMI) was investigated.

Data from 395 STEMI patients registered by the population-based Myocardial Infarction Registry Augsburg between 2009 and 2013 were used for analysis. The OLINK inflammatory panel including a total of 92 cytokines was measured in arterial blood samples, which were obtained immediately after hospital admission within the scope of cardiac catheterization. The associations between the inflammation markers and typical chest pain were examined by multiple logistic regression analyses.

Altogether, 10.9% of the STEMI patients did not present with typical chest pain. The inflammatory markers IL8, IL6, FGF-21, CD40, CST5, ADA, OPG, PD-L1, TNFRSF9 and STAMBP were significantly inversely associated with typical chest pain after FDR-adjustment. The strongest associations were found for FGF-21, CST5 and CD40.

These results suggest that a dysregulated inflammatory status is associated with a lack of typical chest pain in AMI patients. Beyond acute-phase inflammatory interleukins elevated within the early phase of an AMI, such as IL-6, hepatokines and transmembrane proteins seem to be associated with AMI symptoms. Further research into the causal mechanisms of these associations is necessary.