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Plasma Levels of Soluble Tumor Necrosis Factor Receptor Type I During the Acute Phase Following Complicated Myocardial Infarction Predicts Survival in High-Risk Patients

Thor Ueland, PhD^_*,,_*, John Kjekshus, MD, PhD, Stig S. Frøland, MD, PhD^,, Torbjørn Omland, MD, PhD^||, Iain B. Squire, MD^#, Lars Gullestad, MD, PhD, Kenneth Dickstein, MD, PhD^¶ and Pål Aukrust, MD, PhD^,

^_* Section of Endocrinology, National University Hospital, Oslo, Norway
Department of Cardiology, National University Hospital, Oslo, Norway
Section of Clinical Immunology and Infectious Diseases, National University Hospital, Oslo, Norway
Research Institute for Internal Medicine, National University Hospital, Oslo, Norway
^|| Department of Medicine, Akershus University Hospital, Nordbyhagen, Norway
^¶ Cardiology Division, Stavanger University Hospital, Stavanger, Norway
^# Department of Medicine and Therapeutics, University of Leicester, Leicester, United Kingdom

View larger version (24K): [in a new window]   Figure 1 Circulating levels of soluble tumor necrosis factor receptor type 1 (sTNFR1), interleukin (IL)-6, monocyte chemoattractant peptide (MCP)-1, and IL-10 in patients with acute myocardial infarction (AMI) during follow-up (mean ± SEM). *p < 0.001 vs. baseline (BL). Shaded area represents 95% confidence interval for healthy age- and gender-matched controls.

View larger version (38K): [in a new window]   Figure 2 Correlations at baseline between circulating levels of high-sensitivity C-reactive protein (hsCRP) and N-terminal B-type natriuretic peptide (N-BNP) and sTNFR1, IL-6, MCP-1, and IL-10 in patients with post-myocardial infarction heart failure. Other abbreviations as in Figure 1.

View larger version (35K): [in a new window]   Figure 3 Unadjusted risk ratios (RR) for sTNFR1, IL-6, MCP-1, and IL-10 at baseline (closed squares) and at one month (open squares) in relation to incidence of total mortality (death), cardiac death (D), hospitalization for angina, reinfarctions (Reinf), and the composite end point. See text for cut-off values. Other abbreviations as in Figure 1.

View larger version (21K): [in a new window]   Figure 4 Kaplan-Meier curves showing the cumulative incidence of death during the entire study (median follow-up 27 months), according to high and low levels of sTNFR1 (A), hsCRP (B), and N-BNP (C) at baseline. See text for cut-off values. Abbreviations as in Figures 1 and 2.

View larger version (10K): [in a new window]   Figure 5 Circulating levels of sTNFR1 during two-year follow-up in survivors (solid squares) and non-survivors (open squares). *p < 0.001; #p < 0.05; non-survivors vs. survivors. Four non-survivors died after the last sampling (two years). Abbreviations as in Figure 1.