The Association Of TLR4 And MIF With Prognosis After PCI In Acute Myocardial Infarction Patients

Objective:To investigate the predictive value of Toll-like receptor 4(TLR4)combined with macrophage migration inhibitory factor(MIF)for the occurrence of major adverse cardiovascular events(MACE)in patients with acute myocardial infarction(AMI).This would provide a more accurate predictive tool for clinical prognosis assessment,guide clinicians in identifying patients with poor prognosis after PCI in acute myocardial infarction,and develop individualized treatment and follow-up plans.Methods:This study included 175 acute myocardial infarction patients admitted to the Affiliated Hospital of Qingdao University and Qingdao Fuwai Cardiovascular Hospital from June 2021 to June 2022.The patients were divided into the AMI group,and their plasma TLR4 and MIF levels were sampled within 12 hours of symptom onset.Based on the type of myocardial infarction,patients were further divided into STEMI(n=61)and NSTEMI(n=114)groups.and coronary angiography + PCI was performed within 24 hours for those who met the criteria for emergency PCI.Eighty-five patients with normal coronary angiography and blood tests were selected as the control group,and their plasma TLR4 and MIF levels were measured upon admission.The AMI group received standard medication for coronary heart disease during hospitalization and was followed up for six months after discharge.During this time,patients were divided into MACE(n=51)and non-MACE(n=124)groups based on the occurrence of major adverse cardiovascular events.Data were collected for all patients in the AMI and control groups,including gender,age,height,weight,diabetes history,hypertension history,and dyslipidemia history.Systolic blood pressure,diastolic blood pressure,fasting blood glucose,body mass index,total cholesterol,triglycerides,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,and left ventricular ejection fraction were measured and compared between the AMI and control groups.After coronary angiography,data on time from onset to admission,number of affected vessels,KILLIP classification,and in-hospital medication were collected for the AMI group.Statistical analysis was performed using SPSS 26.0 software.Data were analyzed using t-tests,percentages for count data,binary logistic regression,and ROC curve plotting.Differences in count data were expressed as frequencies and analyzed using chi-square tests.Continuous data were expressed as mean ± standard deviation,and differences between two groups were analyzed using independent sample t-tests.Multiple comparisons were performed using ANOVA and LSD tests for data with equal variances.Pearson correlation analysis was used for the correlation analysis between two continuous variables.Results with p<0.05 were considered statistically significant.Results:(1)Comparison of plasma TLR4 and MIF levels between the AMI group and the control groupThe plasma TLR4 level in the AMI group was 60.28±8.84ng/ml,and the MIF level was4.07±1.04ng/ml.In the control group,the plasma TLR4 level was 102.42±24.48ng/ml,and the MIF level was 1.67±0.19ng/ml.Plasma TLR4 and MIF levels were significantly higher in the AMI group compared to the control group(P<0.001 for both).(2)Comparison of plasma TLR4 and MIF levels between STEMI and NSTEMI patients In the STEMI group,TLR4 level was 108.54±21.68ng/ml,and MIF level was4.37±0.86ng/ml.In the NSTEMI group,TLR4 level was 99.14±25.34ng/ml,and MIF level was 3.92±1.10ng/ml.Plasma TLR4 and MIF levels were higher in the STEMI group compared to the NSTEMI group(P<0.05 for both).(3)Analysis of factors influencing the occurrence of MACE in AMI patients During the 6-month follow-up,the MACE occurrence rate in 175 AMI patients was 29.14%(51/175),Logistic regression analysis results showed that Gensini score,MIF,TLR4,and KILLIP classification levels were independent risk factors for MACE occurrence,while LVEF was an independent protective factor for MACE occurrence(P<0.05 for all).(4)Predictive value of plasma TLR4 and MIF levels for MACE occurrence in AMI patients ROC curve analysis showed that the AUC for TLR4 in predicting MACE occurrence in AMI patients was 0.795(95% CI: 0.726-0.865),with an optimal cut-off value of 109.155ng/ml,sensitivity of 0.804,and specificity of 0.710.The AUC for MIF level in predicting MACE occurrence was 0.763(95% CI: 0.688-0.837),with an optimal cut-off value of 3.900ng/ml,sensitivity of 0.941,and specificity of 0.400.The AUC for MIF+TLR4 levels in predicting MACE occurrence was 0.819(95% CI: 0.757-0.881),with a sensitivity of 0.765 and specificity of 0.718.The AUC for MIF+TLR4 levels in predicting MACE occurrence was greater than that for TLR4 and MIF levels alone(P<0.05 for both).Conclusion:TLR4 and MIF levels are elevated in AMI patients,with STEMI patients having higher levels than NSTEMI patients.The individual detection results of TLR4 and MIF have some predictive value for the occurrence of MACE in AMI patients after PCI.However,the combined detection of both factors has a higher predictive value.