Abstract
Acute coronary syndrome is characterized by an acute inflammatory systemic response. We investigated whether timely reperfusion could reduce the inflammatory response in patients with ST-elevation acute myocardial infarction (STEMI). Forty-seven consecutive patients with STEMI eligible for fibrinolysis and admitted to a coronary care unit were enrolled in the study and reperfused with tenecteplase; 33 patients admitted 6 h after the onset of chest pain (late comers), who therefore underwent delayed coronary angioplasty, acted as controls. All patients underwent serial blood sampling in order to evaluate plasma concentrations of C-reactive protein (CRP), fibrinogen and erythrocyte sedimentation rate (ESR) for 4 days. Patients treated with primary (<6 h from symptom onset) or rescue angioplasty were excluded from the study. CRP, ESR and fibrinogen in patients who were timely reperfused showed significantly lower values compared to late comer controls (P < 0.05). In a multivariable analysis considering age, sex, diabetes, presence of anterior wall infarction, presence of Q-waves, left-ventricular ejection fraction and peak troponin levels, timely reperfusion was inversely related to CRP peak values (hazard ratio 0.74, 95% confidence interval 0.55-0.98, P < 0.05). Timely reperfusion can blunt inflammatory activation in patients with STEMI.
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