Study the Value of Interleukin-6 As Diagnostic and Predictive marker of Cardiac Events in St Segment Elevation Myocardial Infarction

Abstract

Abstract Background Owing to major changes in the biomarkers available for diagnosis, criteria for acute myocardial infarction have been revised. The current international consensus definition states that the term acute myocardial infarction (AMI) should be used when there is evidence of myocardial necrosis in a clinical setting consistent with myocardial ischemia. The present guidelines pertain to patients presenting with ischemic symptoms and persistent ST-segment elevation on the electrocardiogram (ECG). Most of these patients will show a typical rise in biomarkers of myocardial necrosis and progress to Q wave myocardial infarction. Separate guidelines have recently been developed by another task force of the ESC (European Society of Cardiology) for patients presenting with ischemic symptoms but without persistent ST segment elevation and for patients undergoing myocardial revascularization in general. Aim of the work The aims of this work are: To assess the diagnostic value of interleukin-6 compared to troponin I in ST segment elevation myocardial infarction. To assess the predictive value of elevated interleukin-6 in ST segment elevation myocardial infarction. Patients This prospective study was included sixty adult patients of both sexes meeting the American Heart Association (AHA) recommendations for diagnosis of ST segment elevation myocardial infarction from those attending the Critical Care Units, Critical Care Medicine Department, Faculty of Medicine, Ain Shams University to be included in the current study. Inclusion Criteria :Patients were fulfilled the criteria of diagnosis of acute coronary syndrome (ACS) and diagnosed as ST segment elevation MI according to American Heart Association (AHA) criteria which include patient ranging between 30 to 70 years and presented with active chest pain. Exclusion Criteria Patients were excluded from the study if they have: (1) Recent myocardial infarction in the last three months. (2) Recent cardiological intervention in the last three months. (3) Recent ischemic cerebrovascular stroke in the last three months. (4) Non ST segment elevation myocardial infarction and unstable angina according to electrocardiographic changes, cardiac markers and clinical condition of the patients. (5) Acute infectious diseases that leads to elevation of troponin I and interleukin-6. (6) Active immunological diseases. (7) Renal impairment. Methods The following data were obtained from each patient: Personal data: name, age, sex, occupation and special habits e.g. smoking. History of present illness regarding to clinical condition: onset, nature, duration, course, progression, characteristic site and radiating areas of the chest pain, relieving and aggravating factors, associated symptoms (as diaphoresis, nausea, vomiting, dyspnea and palpitation) and medication received and their effects. Medical history of diabetes mellitus (DM), hypertension (HTN), and history of ischemic heart disease (IHD). Family history of IHD, DM and HTN. Conclusion From this current study we revealed that: STEMI patients have increased level of interleukin-6 compared to those normal persons. Interleukin-6 may be a potentially useful marker for diagnosis of STEMI. Interleukin-6 may be helpful prognostic value for future cardiac mortality in STEMI patients. The level of interleukin-6 is not affected by the extent of myocardial damage and necrosis. Interleukin-6 is an inflammatory cytokine. Recommendations From this study we recommend the use of interleukin-6 level as good diagnostic marker for diagnosis of ST segment elevation myocardial infarction, Also this study recommend the use of interleukin-6 as good prognostic inflammatory marker in future adverse cardiac events and mortality occur after myocardial infarction STEMI type. Study limitations The results are interpreted in consideration of the small population of patients and short term follow up.