Blunted inflammatory response in STEMI patients timely reperfused.
BACKGROUND
Acute coronary syndrome is characterized by an acute inflammatory systemic response. We investigated whether timely reperfusion could reduce the inflammatory response in patients with ST-elevation acute myocardial infarction (STEMI).


METHODS
Forty-seven consecutive patients with STEMI eligible for fibrinolysis and admitted to a coronary care unit were enrolled in the study and reperfused with tenecteplase; 33 patients admitted 6 h after the onset of chest pain (late comers), who therefore underwent delayed coronary angioplasty, acted as controls. All patients underwent serial blood sampling in order to evaluate plasma concentrations of C-reactive protein (CRP), fibrinogen and erythrocyte sedimentation rate (ESR) for 4 days. Patients treated with primary (<6 h from symptom onset) or rescue angioplasty were excluded from the study.


RESULTS
CRP, ESR and fibrinogen in patients who were timely reperfused showed significantly lower values compared to late comer controls (P < 0.05). In a multivariable analysis considering age, sex, diabetes, presence of anterior wall infarction, presence of Q-waves, left-ventricular ejection fraction and peak troponin levels, timely reperfusion was inversely related to CRP peak values (hazard ratio 0.74, 95% confidence interval 0.55-0.98, P < 0.05).


CONCLUSIONS
Timely reperfusion can blunt inflammatory activation in patients with STEMI.
Cardiology Department, University of Foggia, Foggia, Italy.
Natale Daniele
ND
Brunetti
Michele
M
Correale
Luisa
L
De Gennaro
Andrea
A
Cuculo
Pier Luigi
PL
Pellegrino
Matteo
M
Di Biase
D000368:Aged; D015415:Biomarkers / Q000097:blood; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism; D017023:Coronary Angiography; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000175:diagnosis / Q000276:immunology / Q000517:prevention & control*; D018836:Inflammation Mediators / Q000097:blood; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D012307:Risk Factors; D000077785:Tenecteplase; D015912:Thrombolytic Therapy; D013997:Time Factors; D061665:Time-to-Treatment; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
D015415:Biomarkers; D005343:Fibrinolytic Agents; D018836:Inflammation Mediators; D005340:Fibrinogen; D002097:C-Reactive Protein; D010959:Tissue Plasminogen Activator; D000077785:Tenecteplase