Inflammatory markers 10 weeks after myocardial infarction predict future cardiovascular events.

BACKGROUND

The prognostic value of chronic inflammation markers in patients after myocardial infarction (MI) in the era of interventional treatment, statin and aspirin use is still unclear.

METHODS

The study was carried out on 107 patients with a first MI who were followed up for 18 months. The end points were cardiac death, reinfarction or unstable angina pectoris. At 10 days and at 10 weeks we measured C-reactive protein (CRP), fibrinogen, soluble intercellular adhesion molecule 1 (sICAM-1), erythrocyte sedimentation rate (ESR), white blood cell count (WBC) and Chlamydia preumoniae antibodies.

RESULTS

During the follow-up period there were 22 events. The patients were divided into two subgroups: those with recurrent episodes and those without coronary events. Patients with recurrent episodes had significantly higher values of CRP (7.07 vs. 3.77 mg/l, p = 0.02), ESR at 1 h (24.3 vs. 13.3 mm; p = 0.01) and sICAM-1 (287.9 vs. 260.9 ng/ml, p = 0.04) at 10 weeks following infarction. Statistical analysis showed that sICAM-1 > 270 ng/ml, CRP > 1.83 mg/l and ESR at 1 h > 14 mm measured at 10 weeks were independent risk factors for recurrent cardiovascular events. In patients with coronary events between the 10th day and 10th week there was no decrease in inflammatory indices (WBC, ESR) and a tendency towards increasing sICAM-1.

CONCLUSIONS

Increased inflammatory markers (CRP, ESR, sICAM-1) at 10 weeks after MI are independent risk factors for recurrent cardiovascular events. Measuring CRP, ESR and sICAM-1 at this time point is useful in long-term prognosis after MI. Changes in inflammatory indices (ESR, WBC, sICAM-1) measured at 10 days and 10 weeks following infarction show a different pattern in patients with and without recurrent cardiovascular events. (Cardiol J 2007; 14: 50-58).