title: Relation of inflammatory markers with myocardial and microvascular injury in patients with reperfused ST-elevation myocardial infarction.
abstract: BACKGROUND
  In patients with acute ST-elevation myocardial infarction (STEMI), elevated concentrations of inflammatory markers are correlated with worse clinical outcome. The aim of this study was comprehensively to investigate the relationship of circulating markers of inflammation with myocardial and microvascular damage after STEMI.
  
  
  METHODS
  In 111 consecutive STEMI patients, blood samples were obtained on admission and from day 1 to day 4 after primary percutaneous coronary intervention and analysed for high-sensitivity C-reactive protein (hs-CRP), white blood cell count and fibrinogen. Cardiac magnetic resonance imaging was performed within the first week and 4 months after primary percutaneous coronary intervention.
  
  
  RESULTS
  Peak concentrations of hs-CRP (20.5 (9.6-44.4) mg/L), white blood cell count (12.4 (10.5-15.3) G/L) and fibrinogen (3640 (3150-4550) mg/L) showed significant correlations with both infarct size ( r=0.31 to 0.41; P<0.01) and left ventricular ejection fraction ( r=-0.29 to -0.39; P<0.01) assessed in the acute as well as chronic stage following STEMI. Furthermore, peak concentrations of these inflammatory markers were significantly higher in patients with microvascular obstruction compared to patients without microvascular obstruction ( P⩽0.01). C-statistics revealed that the prognostic values of all three biomarkers for the prediction of large chronic infarct size (>8% of left ventricular myocardial mass) were moderate without significant differences (area under the curve: hs-CRP 0.73 (95% confidence interval (CI) 0.63-0.82), white blood cell count 0.67 (95% CI 0.56-0.78) and fibrinogen 0.69 (95% CI 0.59-0.79); all P>0.12). Combination of inflammatory markers did not significantly increase the area under the curve ( P>0.05).
  
  
  CONCLUSIONS
  In reperfused STEMI patients, increased levels of hs-CRP, white blood cell count and fibrinogen are associated with decreased left ventricular function and more pronounced myocardial damage at baseline and 4 months after infarction.
authors.affiliation: 1 University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Reindl
authors.affiliation: 1 University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria.
authors.forename: Sebastian Johannes
authors.initials: SJ
authors.lastname: Reinstadler
authors.affiliation: 1 University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria.
authors.forename: Hans-Josef
authors.initials: HJ
authors.lastname: Feistritzer
authors.affiliation: 1 University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria.
authors.forename: Gert
authors.initials: G
authors.lastname: Klug
authors.affiliation: 1 University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria.
authors.forename: Christina
authors.initials: C
authors.lastname: Tiller
authors.affiliation: 1 University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria.
authors.forename: Johannes
authors.initials: J
authors.lastname: Mair
authors.affiliation: 2 University Clinic of Radiology, Medical University of Innsbruck, Austria.
authors.forename: Agnes
authors.initials: A
authors.lastname: Mayr
authors.affiliation: 2 University Clinic of Radiology, Medical University of Innsbruck, Austria.
authors.forename: Werner
authors.initials: W
authors.lastname: Jaschke
authors.affiliation: 1 University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Metzler
mesh_terms: D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D003326:Coronary Circulation / Q000502:physiology*; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007249:Inflammation / Q000097:blood*; D007958:Leukocyte Count; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D000072657:ST Elevation Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000601:surgery
chemical_list: D015415:Biomarkers; D005340:Fibrinogen; D002097:C-Reactive Protein
keywords: ST-elevation myocardial infarction; fibrinogen; high-sensitivity C-reactive protein; inflammatory markers; magnetic resonance imaging; white blood cell count