Abstract
Background
The purpose of the study was to assess the value of admission macrophage migration
inhibitory factor (MIF) levels in predicting clinical outcomes in ST-elevation myocardial
infarction (STEMI) patients.
Methods
For this study we recruited 498 STEMI patients after they received percutaneous coronary
intervention (PCI), 40 with stable angina pectoris and 137 healthy participants. Plasma
MIF levels were measured at admission and after PCI. The primary end points were in-hospital
mortality and major adverse cardio-and/or cerebrovascular events (MACCE) during hospitalization
and 3.2-year follow-up period.
Results
Admission MIF levels were elevated in 88.4% of STEMI patients over the upper reference
limit of healthy controls and it was 3- to 7-fold higher than that in stable angina
pectoris and control groups (122 ± 61 vs 39 ± 19 vs 17 ± 8 ng/mL; P < 0.001). Admission MIF levels were significantly higher in patients who died after
myocardial infarction vs survivors. For predicting in-hospital mortality using the
optimal cutoff value (127.8 ng/mL) of MIF, the area under the receiver operating characteristic
curve for MIF was 0.820, similar area under the receiver operating characteristic
curve values for predicting short-term outcomes were observed for high-sensitivity
troponin T, CK-MB, N-terminal probrain natriuretic peptide, and Global Registry of Acute Coronary Events (GRACE) score. Although peak high-sensitivity troponin T and N-terminal probrain
natriuretic peptide also predicted MACCE during the follow-up period, only higher
admission MIF levels predicted in-hospital mortality and MACCE during the 3.2-year
follow-up. Multivariate regression analysis showed the independent predictive value
of a higher admission MIF level (≥ 127.8 ng/mL) on in-hospital mortality (odds ratio,
9.1; 95% confidence interval, 1.7-47.2) and 3.2-year MACCE (hazard ratio, 2.8; 95%
confidence interval, 1.5-5.6).
Conclusions
A higher admission MIF level is an independent predictor for in-hospital mortality
and long-term MACCE in STEMI patients who underwent PCI.
Résumé
Contexte
L’étude visait à évaluer l’utilité du dosage du facteur d’inhibition de la migration
des macrophages (MIF) effectué lors de l’admission à l’hôpital aux fins de pronostic
des résultats cliniques chez les patients ayant souffert d’un infarctus du myocarde
avec élévation du segment ST (STEMI).
Méthodologie
Pour les besoins de cette étude, nous avons recruté 498 patients ayant souffert de
STEMI après qu’ils eurent subi une intervention coronarienne percutanée (ICP), 40
patients atteints d’angine de poitrine stable et 137 sujets en bonne santé. Les concentrations
plasmatiques de MIF ont été mesurées lors de l’admission à l’hôpital et après l’ICP.
Les paramètres d’évaluation principaux étaient la mortalité intrahospitalière et la
survenue d’événements cardiovasculaires et/ou cérébrovasculaires indésirables majeurs
(MACCE) au cours de l’hospitalisation et d’une période de suivi de 3,2 ans.
Résultats
Lors de l’admission à l’hôpital, les concentrations de MIF étaient élevées chez 88,4
% des patients qui avaient souffert de STEMI; elles se situaient au-delà de la limite
supérieure de référence mesurée chez les sujets témoins en bonne santé et étaient
de 3 à 7 fois plus élevées que celles notées chez les patients atteints d’angine de
poitrine stable et les sujets témoins (122 ± 61 vs 39 ± 19 vs 17 ± 8 ng/ml, p < 0,001). Les concentrations de MIF lors de l’admission à l’hôpital étaient significativement
plus élevées chez les patients qui sont décédés après avoir souffert d’un infarctus
du myocarde que chez les survivants. Pour le pronostic de mortalité intrahospitalière
en fonction de la concentration de MIF constituant la valeur seuil optimale (127,8
ng/ml), l’aire sous la courbe ROC était de 0,820. Une aire sous la courbe ROC similaire
a été observée pour le pronostic des résultats à court terme en fonction des concentrations
de troponine T hypersensible, de CK-MB et de NT-proBNP (propeptide natriurétique de
type B N-terminal) et en fonction du score GRACE (Global Registry of Acute Coronary Events). Même si les concentrations maximales de troponine T hypersensible et de NT-proBNP
étaient aussi prédictives des MACCE durant la période de suivi, seules les concentrations
plus élevées de MIF lors de l’admission à l’hôpital constituaient un marqueur pronostique
de mortalité intrahospitalière et de MACCE durant la période de suivi de 3,2 ans.
L’analyse de régression multivariée a montré qu’une concentration plus élevée de MIF
lors de l’admission à l’hôpital (≥ 127,8 ng/ml) constitue un marqueur pronostique
indépendant de mortalité intrahospitalière (rapport des risques instantanés de 9,1;
intervalle de confiance à 95 % de 1,7 à 47,2) et de MACCE sur une période de 3,2 ans
(rapport de cotes de 2,8; intervalle de confiance à 95 %, de 1,5 à 5,6).
Conclusions
Une concentration plus élevée de MIF lors de l’admission à l’hôpital constitue un
marqueur pronostique indépendant de mortalité intrahospitalière et de MACCE à long
terme chez les patients qui ont souffert d’un STEMI et subi une ICP.
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Article info
Publication history
Published online: May 20, 2019
Accepted:
April 29,
2019
Received:
November 12,
2018
Footnotes
See editorial by Haitjema and Hoefer, pages 1281–1282 of this issue.
See page 1375 for disclosure information.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- When the Myocardium Gets MIFfed: Macrophage Inhibitory Factor as a Biomarker in Acute Coronary Artery DiseaseCanadian Journal of CardiologyVol. 35Issue 10
- PreviewSurvival after acute myocardial infarction has improved significantly in the past years and decades. Besides the developments in interventional treatment options, the increasing public awareness of typical symptoms has contributed to a reduced time lag between the onset of symptoms and intervention. However, the differential diagnosis of acute or chronic myocardial ischemia in patients who present with atypical symptoms can be much less straightforward.1 Despite current guidelines that allow for 1-hour ruling in or out of non–ST-elevation myocardial infarction for certain high-sensitivity troponin assays, patients are often left anxious and stressed during the waiting period for the second troponin measurement.
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