Giuseppe Berton, Rosa Palmieri, Rocco Cordiano, Fiorella Cavuto, Sigismondo Pianca and Paolo Palatini

Background The relationship between acute-phase inflammatory markers in the setting of acute myocardial infarction (AMI) and long-term outcomes is largely unexplored.

Objectives The aim of the study was to investigate the predictive power of acute-phase inflammatory markers following AMI for short-term and long-term mortality separately and modes of death.

Methods In 220 unselected patients with AMI [median age 67 (interquartile range 60-74) years, women 26%], blood neutrophil granulocytes, erythrocyte sedimentation rate, C-reactive protein, and a1-acid glycoprotein were measured 1, 3 and 7 days after admission. All patients completed 7 years of follow-up. Endpoints were 1-year (short-term) and 2- to 7-vear (long-term) mortality and modes of death, classified as nonsudden cardiovascular, sudden, and noncardiovascular death.

Results The short-term mortality rate was 18%. The long- term mortality rate was 26%. The short-term mortality risk was higher in patients in whom the markers were in the upper tertile. Fully adjusted hazard ratios (and 95% confidence interval) were 3.2 (1.4-7.9), 3.5 (1.7-7.9), 3.5 (1.6-8.6), and 6.1 (2.3-19.1) for neutrophil granulocyte, erythrocyte sedimentation rate, C-reactive protein, and «i-acid glycoprotein, respectively. The excess mortality was chiefly due to nonsudden cardiovascular mortality

Conclusion The acute-phase inflammatory markers tested following AMI are independently and concordantly associated with short-term mortality and their prediction is associated only with nonsudden cardiovascular modes of death. These markers are not associated with long-term mortality.

Keywords C-reactive protein, inflammatory markers, long-term mortality, myocardial infarction, prognosis, short-term mortality