Publié dans Journal of the American College of Cardiology 2020 Aug 19 :S0735-1097(20)36323-3

Auteurs : Silvain J, Kerneis M, Zeitouni M, Lattuca B, Galier S, Brugier D, Mertens E, Procopi N, Suc G, Salloum T, Frisdal E, Le Goff W, Collet JP, Vicaut E, Lesnik P, Montalescot G, Guerin M.

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Abstract

Journal of the American College of Cardiology

Background :

Inhibition of the interleukin-1β (IL-1β) innate immunity pathway is associated with anti-inflammatory effects and a reduced risk of recurrent cardiovascular events in stable patients with previous myocardial infarction (MI) and elevated high sensitivity C-reactive protein (hs-CRP).

Objectives :

To assess the association between IL-1β level with all-cause mortality in patients with acute ST segment elevation myocardial infarction (MI) undergoing primary percutaneous coronary intervention and the interplay between IL-1β and hs-CRP concentrations on the risk of premature death.

Methods :

IL-1β concentration was measured among 1398 ST segment elevation MI patients enrolled in a prospective cohort. Crude and hazard ratios for all-cause and cardiovascular mortality were analyzed at 90-days and one-year using a multivariate-cox proportional regression analysis. Major cardiovascular events (MACE) were analyzed.

Results :

IL-1β concentration measured at admission was associated with all-cause mortality at 90 days (adjusted hazard ratio [adjHR], 1.47 per 1SD increase; 95% CI, 1.16 to 1.87; p<0.002). The relation was nonlinear, and highest tertile of IL-1β was associated with higher mortality rates at 90 days (adjHR: 2.78; 95%CI: 1.61-4.79, p=0.0002) and one-year (adjHR: 1.93; 95%CI: 1.21-3.06, p=0.005), regardless of the hs-CRP concentration. Significant relationships were equally observed when considering cardiovascular mortality and MACE at 90 days (adjHR: 2.42; 95% CI: 1.36-4.28, p=0.002 and 2.29; 95% CI: 1.31-4.01, p=0.004, respectively) and at one year (adjHR: 2.32; 95% CI: 1.36-3.97, p=0.002 and 2.35; 95% CI: 1.39-3.96, p=0.001, respectively).

Conclusion :

IL-1β measured at admission in acute MI patients is independently associated with the risk of mortality and recurrent MACE.