[Prognostic value of tumor necrosis factor-alpha in patients with ST-segment elevation acute myocardial infarction].
OBJECTIVE
Tumor necrosis factor-alpha (TNFalpha in patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to determine the prognostic value of TNFalpha in this clinical setting at six-month follow-up.


METHODS
The levels of TNFalpha, C-reactive protein (CRP), interleukin 6 and type 1 soluble intercellular adhesion molecules measured within the first 10 h of symptom onset and at 48 h in 74 consecutive patients admitted with STEMI. The relationships between these levels and the incidence of ischemic events (i.e., angina, reinfarction, and death), heart failure (HF), or both (i.e., all cardiovascular events) were studied.


RESULTS
Overall, TNFalpha levels were significantly higher in patients who had an ischemic event or HF than in those who did not (P<.02 for both). At 48 h, the adjusted odds ratios of those in the highest TNFalpha quartile (2.92 pg/mL) for the development of ischemic events, HF, and all cardiovascular events combined were 13.1, 9.59 and 9.75, respectively. A TNFalpha level of 2.04 pg/mL at 48 h had a sensitivity of 78% and a specificity of 72.5% in predicting a cardiovascular event of any form. The CRP level, but not the TNFalpha level, at admission was found to be an independent predictor of the development of a cardiovascular events.


CONCLUSIONS
In patients with STEMI, the plasma TNFalpha level 48 h after symptom onset and the CRP level at admission were independent predictors of cardiovascular events.
Gonzálvez
Manuel
M
Unidad de Cardiología, Hospital General Universitario J.M. Morales Meseguer, Murcia, España. mgonzalvez@smcardiologia.es
Ruiz-Ros
José A
JA
Pérez-Paredes
Matías
M
Lozano
María L
ML
García-Almagro
Francisco J
FJ
Martínez-Corbalán
Francisco
F
Giménez
Diego M
DM
Carrillo
Andrés
A
Carnero
Andrés
A
Cubero
Tomás
T
Gonzálvez
Juan J
JJ
Ureña
Isabel
I
Vicente
Vicente
V
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000097:blood* / Q000209:etiology / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000209:etiology / Q000401:mortality; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications / Q000401:mortality; D011379:Prognosis; D012008:Recurrence; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood
D015415:Biomarkers; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D019010:Vascular Cell Adhesion Molecule-1; D002097:C-Reactive Protein