The Effection And Its Application Of PCI In Different Times On Serum Hs-CRP And IL-6Levels In Patients With STEMI

BackgroundsStenosis and occlusion are the major lacal substrate for myocardial severe ischemia and necrosis, causing to ST-segment elevation myocardial infarction (STEMI). The vulnerable plaque that is prone to rupture, or the secondary thrombosis are the main pathological mechanism factors of STEMI. Myocardial reperfusion timely and effectively may reduce the amount of myocardial necrosis, save the dying myocardial cells and improve heart function and clinical outcome, which is the best treatment. Percutaneous coronary intervention (PCI), providing the most safe and effective treatment for patients with acute myocardial infarction, has been implemented widely. So far, keeping the infarct-related artery recanalisated soon, completely and permanetly is recognized as the best strategy for patients with STEMI. There are a large number of studies have shown that reperfusion within12hours after the incidence of AMI could save the dying myocardial cells, preserve cardiac function and improve prognosis. However, whether the emergency PCI can be helpful to the short-term and long-term prognosis for patients with STEMI beyond12hours after the incidence of syndrom remains controversial. ObjectiveAccording to the time when PCI were performed,all the patients were divided into four groups:A Groups(underwent PCI within6h after onset of STEMI), B Group(underwent PCI between6h with12h after onset of STEMI); C Groups(underwent PCI beyond12h after onset of STEMI), and D Group(without PCI). This report is to examine the relationship between hs-CRP、IL-6and the prognosis of patients with STEMI, and to expore optimal time to perform PCI.Methods1Object of Study and GroupingOne hundred and twenty-seven patients with first ST-segment elevation acute myocardial infarction (STEMI) were enrolled in Cardiology of Wuhan General Hospital from March2010to August2011. group A(n=41) were performed PCI within6hours from onset of symptoms. group B(n=32) were performed PCI between6with12hours from onset of symptoms, group C(n=41) were performed PCI after12hours from onset of symptoms, and group D(n=41) got conservative therapies. Group E(n=10) composed control group with no obvious stenosis juging by the CAG (coronary arteriongraphy). There were no significant difference between five groups in sex, age, risk factors and locations of myocardial infarction.The serum hs-CRP and IL-6Levels in different times, including berore treatment,24hours、48hours、72hours、2weeks and3month were detected in enzymoimmunoassay, following accordance with operating instructions strictly. The cardiovascular events, including hypotension, postfarction angina, cardial shock, cardial death were observed in each group during in-hospital and follow-up period(3months).2Cardiovascular EventsCardiovascular Events, including angina after AMI, recurrent non-fatal myocardial infarction, postoperative hypotension, cardiogenic shock, sudden cardiac death, serious arrhythmias were observed and recorded during in-hospitalization and3months follow-up period.3Statistical AnalysisAll the datas was processed and analysed by SPSS13.0statistical software. All measurement datas were expressed by mean±SD. One-Way ANOVA was used to compare the mean among the three groups as measurement data; multiple comparison by Games Howell (Heterogeneity of variance)或LSD (homogeneity of variance); Paired-Samples T Test or Repeated Measures was used to compare the mean before and after treatment; chi-square test was used in enumeration data; Bonferroni correction of inspection standards was used in the multiple comparison in enumeration data. inspection levels after correction for the α<0.01. P<0.05indicated that the difference was statistically significant. P<0.01was considered statistically different in the multiple comparison in enumeration data.results1the serum levels of hs-CRP and IL-6patients in each group at different times1.1STEMI patients serum hs-CRP levelsThe serum hs-CRP concentration before treatment:there were no difference of serum hs-CRP concentration in patients underwent PCI within6hours after onset of symptoms with control group; those underwent PCI beyond6hours had higher serum hs-CRP concentrations levels.Serum hs-CRP concentration levels in patients at24hours after onset of symptoms were significantly higher than the levels before treatment. The levels in patients underwent PCI went up to peak at48hours after onset of symptoms, non-PCI treatment group reached to peak at72h. Patients underwent PCI had higher serum hs-CRP peak levels than the non-PCI group (14.66±1.54ng/ml vs12.76± 2.20ng/ml,16.05±1.23ng/ml vs12.76±2.20ng/ml,17.37±1.22ng/ml vs12.76±2.20ng/ml, ng/ml, P<0.05).Serum hs-CRP concentration at the second week after onset of symptom compared with control group:Patients underwent PCI12hours after onset of symptoms had no different of hs-CRP concentration levels, compared with the control group (P>0.05), but still higher in those underwent PCI beyond12hours (P <0.05).Serum hs-CRP concentration at the third month after onset of symptom compared with control group:the serum hs-CRP concentration in patients underwent PCI within6hours after onset of symptoms had lower serum hs-CRP concentration, compared with the control group level(P<0.05). but no difference were found in patients underwent PCI beyond6hours after onset of symptoms with control group (P>0.05),1.2STEMI patients serum IL-6levelsThe serum IL-6concentration before treatment:there were no difference of serum IL-6concentration in patients underwent PCI within6hours after onset of symptoms with control group; those underwent PCI beyond6hours had higher serum IL-6concentrations levels.Serum IL-6levels at24hours after the onset of symptoms reached a peak. Higher serum IL-6levels were shown in the PCI groups,compared with non-PCI group (6.08±1.16ng/ml vs5.24±1.04ng/ml,6.67±0.99ng/ml vs5.24±1.04ng/ml,7.10±0.90ng/ml vs5.24±1.04ng/ml, P<0.05).Serum IL-6concentration at the second week after onset of symptom compared with control group:Patients underwent PCI12hours after onset of symptoms had no different of IL-6concentration levels, compared with the control group level (P>0.05), but still higher in those underwent PCI beyond12hours (P<0.05). Serum IL-6concentration at the third month after onset of symptom compared with control group:the serum IL-6concentration in patients underwent PCI within6hours after onset of symptoms had lower serum IL-6concentration, compared with the control group level(P<0.05). but no difference were found in patients underwent PCI beyond6hours after onset of symptoms and control group (P>0.05).2The serum levels of hs-CRP and IL-6on the admmisionThe patients were divided to two groups, according to the incidence of the cardiovascular events, including reccurrent angina, heart failure, serious arrhythmias after myocardial infarction, nonfatal myocardial infarction, cardiogenic shock, cardiac death etc) during hospital and follow-up. The patients happended cardiovascular events had higher hs-CRP levels(5.543±1.578ng/ml vs3.574±1.710ng/ml, t=5.811, P<0.01),and higher IL-6levels (3.498±1.051ng/ml vs2.189±1.179ng/ml, t=5.661, P<0.01).3The correlation between hs-CRP and IL-6There were significant relationship between hs-CRP and IL-6.4the incidence of cardiovascular events during follow-upThere were four patients happened cardiovascular events (2with recurrent angina,1with heart failure,1with cardial rhythm disorders) in Group A; There were eighet patients happened cardiovascular events (3with recurrent angina,2with heart failure,1with cardial rhythm disorders,1with nonfatal myocardial infarction,1with cardial shock) in Group B; There were foutheen patients happened cardiovascular events (4with recurrent angina,3with heart failure,2with rhythm disorders,2with nonfatal myocardial infarction,2with cardial shock) in Group C; There were nintheen patients happened cardiovascular events (1with recurrent angina,6with heart failure,1cardial rhythm disorders,2with nonfatal myocardial infarction,4with sudden death,5with cardial shock) in Group D. Lower rate of cardiovascular events were happened in PCI groups (χ2=22.391, P<0.001). Compared with the group with non-PCI treatment, the patients underwent PCI within6h and those underwent PCI between6and12h had lower rate of cardiovascular events (χ2=30.017, P<0.001; χ2=14.643, P<0.001;α’<0.01). Compared with the group with non-PCI treatment, the patients underwent PCI within6h and those underwent PCI beyond12h had lower rate of cardiovascular events,but on statistical differece were found (χ2=4.342, P=0.035;α’<0.01). Later PCI were performed, higher incidence of cardiovascular events happened, but on statistical differece were found (χ2=3.040, P=0.007, χ2=3.574, P=0.052,α’<0.01).Conclusions(1) Serum levels of hs-CRP and IL-6in patients with STEMI increased gradually. PCI groups showed higher peak levels, while had shortened duration time;(2) The cardiovascular events in patients with STEMI were related significantly with the serum levels of hs-CRP and IL-6before treatment;(3) Earlier PCI can improve the prognosis of patients with STEMI. PCI performed after12hours is helpful.