Post-infarction myocardial remodeling pattern and mace in patients with STEMI: relation and predictors

Objective: Evaluation of the predictors of post-infarc-tion adaptive (AMR) or pathological (PMR) myocardi-al remodeling as well as major adverse cardiovascular events (MACE) in patients with STEMI in a follow up period of 12 months.

Methods: In 240 patients with STEMI who developed averagely in 5 months after angioplasty AMR (n=120) or PMR (n=120) the MACE (cardiovascular death, non-fatal AMI, non-fatal stroke, unstable angina) rate as well as the peripheral artery elasticity indices (C1- large arteries and C2- small arteries, using pulse wave velocity method) and 37 circulating biochemical markers (regarding inflammation, oxidative stress, en-dothelial dysfunction and extracellular matrix) were assayed in following time points: admission, 3rd (ex-pression of macrophage M1) and 7th day (expression of macrophage M2), 1st, 3rd, 6th and 12th month using ELISA method.

Results: In the acute phase of infarction only anti-in-flammatory markers were able to predict remodeling pattern: in patients with AMR since 3rd day has been established an increase of serum content of IL-4 and IL-10, their increment being at 7-th day in a range of 51-57% (p<0.05), while in patients with PMR the in-terleukins rise was negligible, up to 5.3%. At 3rd month the serum level of marker of collagen type I synthesis (PICP) was by 57.3% lower in PMR vs AMR: 47.8 ± 4.3 vs. 111.9 ± 7.8 ng/ml. MACE rate was notable higher in patients with PMR: 15 vs. 4.17%. Noteworthy, the patients with MACE in both series have distinguished themselves through higher significant levels at 1st, 3rd and 6th month of CRPhs, MCP-1 and MMP-9 while C2 index was significantly less in comparison with patients without MACE.

Conclusions: 1. The elevation of serum level of IL-4 and IL-10 in acute phase (day3 –day7) more than 50% predicts adaptive post-infarction remodeling while lowered PICP serum level at 3rd month has a predicti-ve value concerning pathologic remodeling in patients with STEMI. 2. MACE rate increases 3,6 times more in patients with pathological remodeling whose proper predictors in the fist half of year after angioplasty are: CRPhs, MCP-1, MMP-9 and C2 index.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)