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CLINICAL RESEARCH: ACUTE MYOCARDIAL INFARCTION

Early interleukin-1 receptor antagonist elevation in patients with acute myocardial infarction

Giuseppe Patti, MD^*, Andrea D'Ambrosio, MD^*, Simona Mega, MD^*, Gabriele Giorgi, MD, Enrico Maria Zardi, MD, Domenico Maria Zardi, MD, Giordano Dicuonzo, MD^*, Aldo Dobrina, MD^* and Germano Di Sciascio, MD, FACC, FESC^*,*

^* Department of Cardiovascular Sciences, Campus Bio-Medico University, Rome, Italy
Division of Cardiology, "San Sebastiano Martire" Hospital, Frascati, Italy

Manuscript received April 30, 2003; revised manuscript received July 4, 2003, accepted July 14, 2003.

^* Reprint requests and correspondence: Dr. Germano Di Sciascio, Department of Cardiovascular Sciences, Campus Bio-Medico University, Via E. Longoni, 83, 00155 Rome, Italy.
g.disciascio{at}unicampus.it

OBJECTIVES: We sought to evaluate interleukin-1 receptor antagonist (IL-1Ra) levels in patients with ST-segment elevation acute myocardial infarction (AMI) upon emergency department (ED) admission in order to assess the sensitivity of such a determination by comparison with common markers of myocardial necrosis.

BACKGROUND: Inflammatory markers are elevated in patients with unstable coronary syndromes, but IL-1Ra levels during the early phases of AMI have not been previously investigated.

METHODS: Levels of IL-1Ra were measured in 44 consecutive patients with AMI and compared with creatine kinase (CK), CK-MB, troponin I, myoglobin, and C-reactive protein (CRP).

RESULTS: Upon admission, 82% of patients had elevated (>230 pg/ml) IL-1Ra levels, compared with 41% of patients with raised CK (p = 0.001), CK-MB (45%, p = 0.002), troponin I (57%, p = 0.027), myoglobin (48%, p = 0.004), and CRP (57%, p = 0.019) levels. The IL-1Ra values were significantly higher in patients with heralded AMI than in those without pre-infarction angina (671 vs. 320 pg/ml, p = 0.013). The sensitivity of IL-1Ra determination increased to 86% when chest pain duration was 3 h and to 91% if heralded infarction occurred.

CONCLUSIONS: Our study indicates that, unlike markers of necrosis, an increase of IL-1Ra levels occurs early in patients with AMI, is more significant in those with heralded infarction and symptom onset 3 h, and precedes the release of markers of necrosis. Thus, IL-1Ra determination may be an important early adjuvant toward the diagnosis of AMI in the ED.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CK = creatine kinase   CRP = C-reactive protein   ED = emergency department   IL-1Ra = interleukin-1 receptor antagonist

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