title: Inflammatory and thrombotic markers in patients with ST-elevation myocardial infarction treated with thrombolysis and early PCI: a NORDISTEMI substudy.
abstract: BACKGROUND
  Both pharmacological and invasive treatment might influence the inflammatory and pro-thrombotic responses observed in acute ST-elevation myocardial infarction (STEMI). We aimed to study whether circulating levels of inflammatory and pro-thrombotic markers differ in STEMI patients treated with early angioplasty compared to standard therapy following thrombolysis. Furthermore, we wanted to study if levels of markers were related to infarct size.
  
  
  METHODS
  This was a substudy of the NORwegian study on DIstrict treatment of ST-Elevation Myocardial Infarction (NORDISTEMI), in which STEMI patients treated with thrombolysis were randomized to early invasive or standard therapy. Fasting blood samples were collected in the morning 3 days and 3 months after onset of STEMI. Commercially available ELISA methods were used for determination of inflammatory and pro-thrombotic markers. Infarct size was assessed by SPECT after 3 months.
  
  
  RESULTS
  246 patients were included in this substudy. At 3 days, levels of prothrombin fragment 1+2 and D-dimer were higher in the early invasive compared to the standard treatment group, whereas levels of soluble CD40 ligand were lower (p<0.01 for all). No other differences between groups were found in any of the measured markers. Significant, although weak correlations were found between Day 3 levels of C-reactive protein, interleukin-6, prothrombin fragment 1+2 and D-dimer, and infarct size assessed by SPECT after 3 months.
  
  
  CONCLUSIONS
  An early invasive strategy following thrombolysis for STEMI was associated with higher subacute levels of D-dimer and prothrombin fragment 1+2, and lower levels of soluble CD40 ligand than standard treatment. Further studies are needed to establish the relation between these changes and clinical outcome. The NORDISTEMI was registered at www.clinicaltrials.gov, NCT00161005.
authors.affiliation: Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway. sigrun.h@online.no
authors.forename: Sigrun
authors.initials: S
authors.lastname: Halvorsen
authors.forename: Ingebjørg
authors.initials: I
authors.lastname: Seljeflot
authors.forename: Thomas
authors.initials: T
authors.lastname: Weiss
authors.forename: Ellen
authors.initials: E
authors.lastname: Bøhmer
authors.forename: Harald
authors.initials: H
authors.lastname: Arnesen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001779:Blood Coagulation Factors / Q000032:analysis*; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D015897:Comorbidity; D003328:Coronary Thrombosis / Q000097:blood* / Q000196:embryology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000453:epidemiology / Q000628:therapy*; D009205:Myocarditis / Q000097:blood* / Q000453:epidemiology; D009664:Norway / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001779:Blood Coagulation Factors