Proinflammatory cytokines in acute myocardial infarction with and without cardiogenic shock.
BACKGROUND
Inflammatory response is an important feature of acute coronary syndromes and myocardial infarction (MI). The prognostic value of proinflammatory cytokines in patients with acute MI complicated by cardiogenic shock is unknown.


RESULTS
In 41 patients admitted with acute MI (age 60 +/- 11 years, six females, 19 Killip class IV) serial plasma concentration of tumor necrosis factor alpha (TNF-alpha), interleukin 6 (IL-6) and interleukin 1 receptor antagonist (IL-1Ra) were measured. Seven patients with cardiogenic shock (CS) developed a systemic inflammatory response syndrome (SIRS). Patients with CS-particularly those who developed SIRS-showed significantly higher cytokine levels than patients with uncomplicated MI. In patients with CS and SIRS peak levels of IL-1Ra were 223,973 pg/ml, IL-6 252.8 pg/ml and TNF-alpha 7.0 pg/ml. In CS without SIRS IL-1Ra levels were 19,988 pg/ml, IL-6 109.3 pg/ml and TNF-alpha 3.8 pg/ml. In uncomplicated MI peak IL-1Ra levels were 1,088 pg/ml, IL-6 34.1 pg/ml and TNF-alpha 2.6 pg/ml.


CONCLUSIONS
The inflammation-associated cytokines TNF-alpha, IL-6 and IL-1Ra are significantly elevated in patients with MI complicated by CS when compared to patients with uncomplicated MI. Among shock-patients IL-1Ra levels are promising diagnostic markers for early identification of patients developing SIRS, heralding a poor outcome.
Debrunner
Marianne
M
Division of Cardiology, Department of Internal Medicine , Stadtspital Triemli, Birmensdorferstrasse 497, 8063, Zurich, Switzerland.
Schuiki
Ernst
E
Minder
Elisabeth
E
Straumann
Edwin
E
Naegeli
Barbara
B
Mury
Raymond
R
Bertel
Osmund
O
Frielingsdorf
Jürgen
J
D015415:Biomarkers / Q000097:blood; D016207:Cytokines / Q000097:blood*; D003937:Diagnosis, Differential; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007118:Immunoassay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000097:blood* / Q000175:diagnosis / Q000209:etiology
D015415:Biomarkers; D016207:Cytokines