Systemic Vulnerability, as Expressed by I-CAM and MMP-9 at Presentation, Predicts One Year Outcomes in Patients with Acute Myocardial Infarction-Insights from the VIP Clinical Study

Diana Opincariu, Ioana Rodean, Nora Rat, Roxana Hodas, Imre Benedek, Theodora Benedek, Diana Opincariu, Ioana Rodean, Nora Rat, Roxana Hodas, Imre Benedek, Theodora Benedek

Abstract

(1) Background: The prediction of recurrent events after acute myocardial infarction (AMI) does not sufficiently integrate systemic inflammation, coronary morphology or ventricular function in prediction algorithms. We aimed to evaluate the accuracy of inflammatory biomarkers, in association with angiographical and echocardiographic parameters, in predicting 1-year MACE after revascularized AMI. (2) Methods: This is an extension of a biomarker sub-study of the VIP trial (NCT03606330), in which 225 AMI patients underwent analysis of systemic vulnerability and were followed for 1 year. Hs-CRP, MMP-9, IL-6, I-CAM, V-CAM and E-selectin were determined at 1 h after revascularization. The primary end-point was the 1-year MACE rate. (3) Results: The MACE rate was 24.8% (n = 56). There were no significant differences between groups in regard to IL-6, V-CAM and E-selectin. The following inflammatory markers were significantly higher in MACE patients: hs-CRP (11.1 ± 13.8 vs. 5.1 ± 4.4 mg/L, p = 0.03), I-CAM (452 ± 283 vs. 220.5 ± 104.6, p = 0.0003) and MMP-9 (2255 ± 1226 vs. 1099 ± 706.1 ng/mL p = 0.0001). The most powerful predictor for MACE was MMP-9 of >1155 ng/mL (AUC-0.786, p < 0.001) even after adjustments for diabetes, LVEF, acute phase complications and other inflammatory biomarkers. For STEMI, the most powerful predictors for MACE included I-CAM > 239.7 ng/mL, V-CAM > 877.9 ng/mL and MMP-9 > 1393 ng/mL. (4) Conclusions: High levels of I-CAM and MMP-9 were the most powerful predictors for recurrent events after AMI for the overall study population. For STEMI subjects, the most important predictors included increased levels of I-CAM, V-CAM and MMP-9, while none of the analyzed parameters had proven to be predictive. Inflammatory biomarkers assayed during the acute phase of AMI presented a more powerful predictive capacity for MACE than the LVEF.

Keywords: MMP-9; acute myocardial infarction; angiographical characteristics; predictors for 1 year-MACE; serum inflammatory biomarkers.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Distribution of primary (a) and secondary (b) study end-points for the overall study population.
Figure 2
Figure 2
MACE rates in STEMI versus NSTEMI patients. The occurrence of 1 year MACE was significantly more frequent in patients with NSTEMI.
Figure 3
Figure 3
ROC analysis for the accuracy of serum and imaging markers in predicting 1 year MACE in patients with AMI. (a) ROC curve for hs-CRP in predicting MACE; (b) ROC curve for I-CAM in predicting MACE; (c) ROC curve for MMP-9 in predicting MACE; (d) ROC curve for LVEF% in predicting MACE.

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