INFLAMMATORY REACTION IN ACUTE MYOCARDIAL -INFARCTION - PREDICTIVE VALUES

Introduction and objectives. Our purpose was to investigate the signif icance of inflammatory acute phase response early after myocardial inf arction. We also observed how these indices were influenced by trombol ytic therapy. Method. We examined the blood samples of 200 non consecu tive patients at the first day of acute myocardial infarction (155 [77 %] males; mean age 65 +/- 13 years) to characterize the proteins and p roinflamatory reactants profile. Results were correlated with hospital mortality. Thrombolytic therapy was administrated to 117 patients on admission and in these patiens the samples were taken after the proced ure. Results. Overall mortality was 8%. Serum C-reactive protein (69 v s 41 mg/l), haptoglobine (237 vs 190 mg/dl), gammaglobuline (0.93 vs 0 .84 g/dl), alpha-1-globuline (0.28 vs 0.23 g/dl) and alpha-2-globuline (0.7 vs 0.6 g/dl) were significantly higher in patients without tromb olytic therapy. Conversely, patients who had received lyric therapy, h ad higher plasma concentrations of interleukin-1beta (104 vs 40 pg/dl) . The only clinical variable which was associated with mortality was a Killip class greater than or equal to 2 on admission (mortality = 21% ; odds ratio = 5.2; p = 0.02). Other biochemical variables associated with a higher mortality were a white blood cell count > 10/nl (mortali ty = 12%; odds ratio = 5.4; p = 0.01), increased activated neutrophils > 80% (mortality = 18%; odds ratio = 5.4; p = 0.004) and C-reactive p rotein > 20 mg/l (mortality = 11%; odds ratio = 6; p = 0.05). Only pat ients with activated neutrophils > 80% on admission had a higher proba bility of dying during hospital stay (Exp[B] = 3.6; B = 1.2; r = 0.29; p = 0.001). Conclusion. The acute phase reaction in early myocardial infarction is determined by thrombolytic treatment. A high increase of actived neutrophils on patient admission is the only biochemical pred ictive value for hospital mortality.