Association of Intramyocardial Hemorrhage With Inflammatory Biomarkers in Patients With ST-Segment Elevation Myocardial Infarction

• Published in: JACC. Advances (Online) Vol. 4; no. 4; p. 101647
• Main Authors: Tiller, Christina, Reindl, Martin, Holzknecht, Magdalena, Lechner, Ivan, Oberhollenzer, Fritz, von der Emde, Sebastian, Kaser, Alex, Mayr, Agnes, Pamminger, Mathias, Gollmann-Tepeköylü, Can, Bauer, Axel, Metzler, Bernhard, Reinstadler, Sebastian J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2025; Elsevier
• Subjects: cardiac magnetic resonance; Cardiovascular; inflammation; intramyocardial hemorrhage; Original Research; risk stratification; ST-segment elevation myocardial infarction; risk stratification; IL; WBCc; IMH; MVO; CMR; LVMM; LV; intramyocardial hemorrhage; I/R; NT-proBNP; hs-cTnT; inflammation; MACE; PCI; STEMI; ST-segment elevation myocardial infarction; cardiac magnetic resonance; hs-CRP; major adverse cardiac events; high-sensitivity C-reactive protein; percutaneous coronary intervention; high-sensitivity cardiac troponin T; left ventricular; interleukin; white blood cell count; microvascular obstruction; ischemia-reperfusion; left ventricular myocardial mass; N-terminal pro-B-type natriuretic peptide
• ISSN: 2772-963X; 2772-963X
• DOI: 10.1016/j.jacadv.2025.101647

Ischemia-reperfusion (I/R) injury patterns detected by cardiac magnetic resonance imaging after percutaneous coronary intervention (PCI) have important prognostic implications and trigger inflammatory processes that can further enhance myocardial tissue damage. The authors aimed to investigate the association of circulating inflammatory markers and I/R injury patterns in patients with ST-segment elevation myocardial infarction (STEMI). This observational study included 456 STEMI patients. Peripheral venous blood samples were drawn 48 hours after PCI for analysis of high-sensitivity C-reactive protein (hs-CRP), white blood cell count (WBCc), and interleukin (IL)-6. The presence of I/R injury was defined by the detection of intramyocardial hemorrhage (IMH) according to cardiac magnetic resonance T2∗. Clinical endpoint was the occurrence of major adverse cardiac events, defined as composite of all-cause death, nonfatal reinfarction, and new congestive heart failure. IMH was present in 150 (33%) patients. Hs-CRP (OR: 2.89; 95% CI: 1.96-4.26; P < 0.001), WBCc (OR: 1.32; 95% CI: 1.04-1.67; P = 0.021), and IL-6 (OR: 1.86; 95% CI: 1.38-2.51; P < 0.001) were associated with presence of IMH. Only hs-CRP was independently associated with IMH (OR: 1.95; 95% CI: 1.30-2.93; P = 0.001) after adjustment for other clinical parameters. Furthermore, patients with hs-CRP levels above the median (>26.4 mg/L) were more likely to experience major adverse cardiac events (12% vs 4%, P = 0.002) during a median follow-up of 12 (Q1-Q3: 12-13) months. In patients with STEMI treated with primary PCI, inflammatory parameters including hs-CRP, WBCc, and IL-6 were significantly associated with I/R injury as defined by IMH. After adjustment for other factors, hs-CRP was the only independent inflammatory biomarker associated with IMH. [Display omitted]