State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China; Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
Can J Cardiol. 2019 Oct;35(10):1366-1376. doi: 10.1016/j.cjca.2019.04.028. Epub 2019 May 21.
The purpose of the study was to assess the value of admission macrophage migration inhibitory factor (MIF) levels in predicting clinical outcomes in ST-elevation myocardial infarction (STEMI) patients.
For this study we recruited 498 STEMI patients after they received percutaneous coronary intervention (PCI), 40 with stable angina pectoris and 137 healthy participants. Plasma MIF levels were measured at admission and after PCI. The primary end points were in-hospital mortality and major adverse cardio-and/or cerebrovascular events (MACCE) during hospitalization and 3.2-year follow-up period.
Admission MIF levels were elevated in 88.4% of STEMI patients over the upper reference limit of healthy controls and it was 3- to 7-fold higher than that in stable angina pectoris and control groups (122 ± 61 vs 39 ± 19 vs 17 ± 8 ng/mL; P < 0.001). Admission MIF levels were significantly higher in patients who died after myocardial infarction vs survivors. For predicting in-hospital mortality using the optimal cutoff value (127.8 ng/mL) of MIF, the area under the receiver operating characteristic curve for MIF was 0.820, similar area under the receiver operating characteristic curve values for predicting short-term outcomes were observed for high-sensitivity troponin T, CK-MB, N-terminal probrain natriuretic peptide, and Global Registry of Acute Coronary Events (GRACE) score. Although peak high-sensitivity troponin T and N-terminal probrain natriuretic peptide also predicted MACCE during the follow-up period, only higher admission MIF levels predicted in-hospital mortality and MACCE during the 3.2-year follow-up. Multivariate regression analysis showed the independent predictive value of a higher admission MIF level (≥ 127.8 ng/mL) on in-hospital mortality (odds ratio, 9.1; 95% confidence interval, 1.7-47.2) and 3.2-year MACCE (hazard ratio, 2.8; 95% confidence interval, 1.5-5.6).
A higher admission MIF level is an independent predictor for in-hospital mortality and long-term MACCE in STEMI patients who underwent PCI.
本研究旨在评估入院时巨噬细胞移动抑制因子（MIF）水平对 ST 段抬高型心肌梗死（STEMI）患者临床结局的预测价值。
本研究纳入 498 例行经皮冠状动脉介入治疗（PCI）的 STEMI 患者，其中 40 例为稳定型心绞痛患者，137 例为健康对照者。入院时及 PCI 后检测血浆 MIF 水平。主要终点为住院期间及 3.2 年随访期间的院内死亡率和主要不良心脑血管事件（MACCE）。
STEMI 患者入院时 MIF 水平高于健康对照组的上限参考值，是稳定型心绞痛组和对照组的 37 倍（122±61 比 39±19 比 17±8 ng/ml；P<0.001）。与存活者相比，心肌梗死后死亡患者的入院 MIF 水平显著升高。采用 MIF 的最佳截断值（127.8ng/ml）预测住院期间死亡率，MIF 的受试者工作特征曲线下面积为 0.820，预测短期结局的曲线下面积值与高敏肌钙蛋白 T、CK-MB、N 末端脑利钠肽原和全球急性冠状动脉事件注册（GRACE）评分相似。虽然峰值高敏肌钙蛋白 T 和 N 末端脑利钠肽原也预测了随访期间的 MACCE，但只有较高的入院 MIF 水平预测了 3.2 年随访期间的住院死亡率和 MACCE。多变量回归分析显示，入院 MIF 水平较高（≥127.8ng/ml）与住院死亡率（优势比，9.1；95%置信区间，1.747.2）和 3.2 年 MACCE（风险比，2.8；95%置信区间，1.5~5.6）独立相关。
入院时较高的 MIF 水平是接受 PCI 的 STEMI 患者住院期间死亡率和长期 MACCE 的独立预测因子。
