Correlation Between Peri-procedural Changes Of Serum Inflammatory Cytokines And Early Prognosis In Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

BackgroundAcute myocardial infarction(AMI) is a dangerous disease of severe emergency, endangering people’s lives and health. With the carrying out of percutaneous coronary intervention(PCI),the treatment to AMI has been significantly improved. Clinical studies have shown that inflammatory reaction is the pathological basis when coronary heart disease develops,and is an important mechanism through atherosclerosis.Even in patients whit acute myocardial infarction teated with PCI, it has continued to exist.This experiment try to investigate the variation and clinical significance of inflammatory cytokines interleukin-6(IL-6),interleukin-18(IL-18), high-sensitivity C-reaction protein( hs-CRP), tumor necrosis factor-α(TNF-α) and matrix metalloproteinase-9(MMP-9) in AMI paitients treated with PCI by measuring their serum levels before and after operation.ObjectiveTo investigate the prognosis significance of pre-and post- operation serum inflammatory cytokines changes in patients with acute myocardial infarctionMethodsA total of 118 incipient AMI patients successfully underwent PCI were enrolled in thisstudy(treatment group, including 47 cases of single vascular lesions group, 55 cases of double vascular lesions group and 16 patients of three or more vascular lesions group, blood samples were selected from pre-operation, post-operation 12 h,24h,48 h and postoperative follow-up period). 52 diagnostic coronary angiography(CAG) controls(control group, blood samples collected prior to CAG, 12 h,24 h,48h after CAG and follow-up period). Serum level of IL-6,IL-18,hs-CRP、TNF-α,MMP-9 were measured in all the subjects by enzyme-linked immune sorbent assay(ELISA). All patients were followed up for 90 days. The logistic regression analysis was used to evaluate predictive values of postprocedural IL-6,IL-18,hs-CRP and TNF-αfor major adverse cardiac events(MACE) at 90 days after PCI. Time-to-event analyses were performed using the Kaplan-Meier survival curves in patients with various ranges of postprocedural IL-6, IL-18,TNF-α and hs-CRP.ResultsThere were no differences in baseline levels of IL-6,IL-18,hs-CRP,TNF-α,MMP-9 between the two study groups. And also no significant change was found in control group(before operation to 12 h,24h,48 h,90d after the CAG). The serum level of IL-6, IL-18,hs-CRP,TNF-α in PCI group were significantly increased compared to those before treatment(P<0.01). No significant change was found in MMP-9. Meanwhile, both before and after treatment, AMI patients with two- and multi-vessel stenosis had higher hs-CRP,TNF-α,IL-6 and IL-18 level than those with one-vessel did(P<0.05); no difference was noted in MMP-9 level among the 3 groups. Additional ly, there were significant differences in the levels of IL-6,IL-18,hs-CRP,TNF-α b etween MACE group and non-MACE group after PCI. The multivariable logistic analysis showed that IL-6,IL-18,hs-CRP and TNF-α were risk factors of MAC E after 90 days follow-up.Conclusion1, The concentration of serum IL-6,IL-18,hs-CRP and TNF-α were significantly increased in AMI patients treated with PCI, and the serum levels had a positive correlation with the severity of disease(P<0.05). The PCI operation may induce inflammatory reaction.2, High levels of peripheral inflammatory cytokines IL- 6, IL- 18, hs-CRP and TNF-α had important reference value for major adverse cardiac events(MACE)and short-term prognosis in first AMI patients treated with successful primary PCI.