Wen Cao, Liye Meng, Xiaojuan Wu, Langcheng Yang, Wei Gan, Weihua Feng, Junlong Zhang, Bei Cai
This study revealed that AMI triggered a high-grade systemic inflammatory status contrasted to that in VHD. Crucially, the upstream inflammatory mediator IL-1β was identified as an independent risk factor for in-hospital mortality in AMI patients. Whatever in the prognosis performance or risk assessment IL-1β-based risk score had the similar effects to GRACE score.
PURPOSE: Inflammation is a common pathway in acute or chronic cardiac injury. This study aimed to explore the characteristics of systemic inflammatory responses in acute myocardial infarction (AMI) and find the key inflammatory factors in the prognosis of AMI patients.
PATIENTS AND METHODS: A total of 146 patients with AMI and 468 patients with valvular heart disease (VHD) from West China Hospital of Sichuan University between January 2022 to September 2024 were included in this retrospective study using electronic medical records. Plasma cytokines (including IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p70, IL-17, interferon-α, interferon-γ, and tumor necrosis factor-α) were detected by flow cytometry within 24 hours of admission. Multivariate logistic regression analysis and survival analysis were conducted to identify factors independently associated with in-hospital mortality in AMI patients.
RESULTS: AMI patients exhibited an acute "high inflammatory status", characterized by markedly elevated Interleukin (IL)-6 and IL-10, compared with the low-grade inflammation in VHD (all P<0.001). The multivariate logistic regression model showed that except for the traditional risk factors (age, systolic blood pressure, and heart rate), IL-1β (odds ratio (OR)=1.093, 95% confidence intervals(CI): 1.019-1.172) remained an independent predictor of in-hospital mortality in AMI patients. The IL-1β-based model provided discrimination similar to the Global Registry of Acute Coronary Events Score (AUC 0.819 vs 0.812), and both scores demonstrated significant dose-response associations with mortality risk (IL-1β-based risk score: Hazard Ratio(HR) = 2.67 per SD, 95% CI: 1.82-3.90; GRACE score: HR = 2.66 per SD, 95% CI: 1.75-4.05).
CONCLUSION: This study revealed that AMI triggered a high-grade systemic inflammatory status contrasted to that in VHD. Crucially, the upstream inflammatory mediator IL-1β was identified as an independent risk factor for in-hospital mortality in AMI patients. Whatever in the prognosis performance or risk assessment IL-1β-based risk score had the similar effects to GRACE score.