Prognostic Significance of TNF-α and hs-CRP in Acute Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention

Objective: To evaluate the prognostic value of serum levels of tumor necrosis factor-α (TNF-α) and high sensitivity C-reactive protein (hs-CRP) in patients with acute myocardial infarction (AMI) treated with percutaneous coronary intervention (PCI). Methods: A total of 152 consecutive AMI patients underwent successful PCI were enrolled in this study. The serum levels of TNF-α and hs-CRP were measured within 12 hours after PCI. All patients were followed up for 1 year. The logistic regression analysis was used to evaluate predictive values of postprocedural TNF-α and hs-CRP for major?adverse cardiac events (MACE) at 30 days and 1 year after PCI. Time-to-event analyses were performed using the Kaplan-Meier survival curves in patients with various ranges of postprocedural TNF-α and hs-CRP. Results: There were significant differences in percentage of anterior myocardial infarction, the peak of creatine kinase MB, left ventricular ejection fraction and TNF-α and hs-CRP levels between MACE group and non-MACE group after PCI. The multivariable logistic analysis showed that TNF-α and hs-CRP were risk factors of MACE after 30 days and 1 year follow-up. There were significantly lower 30-day and 1-year survival rates in patients with higher postprocedural TNF-α level after PCI than those of patients with lower postprocedural TNF-α level. But there was no significant difference in 30-day survival rate between patients with higher postprocedural hs-CRP level and patients with lower hs-CRP level, and 1-year cumulative survival rate was significantly decreased. There were significantly higher recurrent myocardial infarction rate after 1-year, revascularization rates after 30-days and 1-year in patients with higher TNF-α level than those of patients with lower TNF-α level. Compared with those in lower hs-CRP group, there were significantly lower recurrent myocardial infarction rates and revascularization rates after 30-day and 1-year in patients with higher hs-CRP after PCI. Conclusion: Increased postprocedural levels of TNF-α and hs-CRP are closely related with short and long-term MACE in first AMI patients treated with successful primary PCI.