Association of Intramyocardial Hemorrhage With Inflammatory Biomarkers in Patients With ST-Segment Elevation Myocardial Infarction.

BACKGROUND

Ischemia-reperfusion (I/R) injury patterns detected by cardiac magnetic resonance imaging after percutaneous coronary intervention (PCI) have important prognostic implications and trigger inflammatory processes that can further enhance myocardial tissue damage.

OBJECTIVES

The authors aimed to investigate the association of circulating inflammatory markers and I/R injury patterns in patients with ST-segment elevation myocardial infarction (STEMI).

METHODS

This observational study included 456 STEMI patients. Peripheral venous blood samples were drawn 48 hours after PCI for analysis of high-sensitivity C-reactive protein (hs-CRP), white blood cell count (WBCc), and interleukin (IL)-6. The presence of I/R injury was defined by the detection of intramyocardial hemorrhage (IMH) according to cardiac magnetic resonance T2∗. Clinical endpoint was the occurrence of major adverse cardiac events, defined as composite of all-cause death, nonfatal reinfarction, and new congestive heart failure.

RESULTS

IMH was present in 150 (33%) patients. Hs-CRP (OR: 2.89; 95% CI: 1.96-4.26; P < 0.001), WBCc (OR: 1.32; 95% CI: 1.04-1.67; P = 0.021), and IL-6 (OR: 1.86; 95% CI: 1.38-2.51; P < 0.001) were associated with presence of IMH. Only hs-CRP was independently associated with IMH (OR: 1.95; 95% CI: 1.30-2.93; P = 0.001) after adjustment for other clinical parameters. Furthermore, patients with hs-CRP levels above the median (>26.4 mg/L) were more likely to experience major adverse cardiac events (12% vs 4%, P = 0.002) during a median follow-up of 12 (Q1-Q3: 12-13) months.

CONCLUSIONS

In patients with STEMI treated with primary PCI, inflammatory parameters including hs-CRP, WBCc, and IL-6 were significantly associated with I/R injury as defined by IMH. After adjustment for other factors, hs-CRP was the only independent inflammatory biomarker associated with IMH.