Marcel Benkhoff, Karin Alde, Vincent Ehreiser, Jana Dahlmanns, Daniel Metzen, Jean M Haurand, Dragos Andrei Duse, Christian Jung, Malte Kelm, Tobias Petzold, Amin Polzin
{"title":"血栓性炎症与 ST 段抬高型心肌梗死后的临床预后有关。","authors":"Marcel Benkhoff, Karin Alde, Vincent Ehreiser, Jana Dahlmanns, Daniel Metzen, Jean M Haurand, Dragos Andrei Duse, Christian Jung, Malte Kelm, Tobias Petzold, Amin Polzin","doi":"10.1182/bloodadvances.2024014273","DOIUrl":null,"url":null,"abstract":"<p><p>Platelets are crucial in thrombus formation during ST-elevation myocardial infarction (STEMI). In addition, they also play an important role in post-ischemic thromboinflammation which is determined by the interplay between activated platelets and neutrophils. The latter form neutrophil extracellular traps (NETs) which are detectable in plasma as citrullinated histone H3 - DNA complexes. Prediction of risk of recurrent events is important in precision medicine. Therefore, we investigated if circulating thromboinflammatory markers predict clinical outcome after STEMI. We performed a prospective, multicentric, observational, all-comer study of STEMI patients (n=361). Thromboinflammation, measured as H3Cit-DNA complexes, was assessed on day one after presentation with STEMI as well as five days and six months after STEMI by ELISA. Twelve months clinical follow-up was conducted. Multivariate analysis was performed investigating which variables were independently associated with major adverse cardiac events (MACE). Patients were 64 ± 12 years old, 80 % male and 40 % had diabetes mellitus. Thromboinflammation was enhanced during index hospitalization as compared to six months follow-up (137.4 ± 100.0 µg/l vs. 53.7 ± 54.7 µg/l, p<0.001). Additionally, patients within the highest tertile of thromboinflammation at day one after STEMI showed worse outcome during follow-up (HR 2.57, CI 1.72-3.85, p<0.001). Receiver operating characteristics (ROC) analysis revealed a cut-off value of 219.3 µg/l. In multivariate logistic regression analysis, thromboinflammation was independently associated with outcome after STEMI. To sum it up, thromboinflammation is enhanced in STEMI. It identifies patients at high risk of MACE. Therefore, thromboinflammation might be a promising target and marker in precision medicine. Trial Registration Number: NCT03539133.</p>","PeriodicalId":9228,"journal":{"name":"Blood advances","volume":null,"pages":null},"PeriodicalIF":7.4000,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Thromboinflammation is associated with clinical outcome after ST-elevation myocardial infarction.\",\"authors\":\"Marcel Benkhoff, Karin Alde, Vincent Ehreiser, Jana Dahlmanns, Daniel Metzen, Jean M Haurand, Dragos Andrei Duse, Christian Jung, Malte Kelm, Tobias Petzold, Amin Polzin\",\"doi\":\"10.1182/bloodadvances.2024014273\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Platelets are crucial in thrombus formation during ST-elevation myocardial infarction (STEMI). In addition, they also play an important role in post-ischemic thromboinflammation which is determined by the interplay between activated platelets and neutrophils. The latter form neutrophil extracellular traps (NETs) which are detectable in plasma as citrullinated histone H3 - DNA complexes. Prediction of risk of recurrent events is important in precision medicine. Therefore, we investigated if circulating thromboinflammatory markers predict clinical outcome after STEMI. We performed a prospective, multicentric, observational, all-comer study of STEMI patients (n=361). Thromboinflammation, measured as H3Cit-DNA complexes, was assessed on day one after presentation with STEMI as well as five days and six months after STEMI by ELISA. Twelve months clinical follow-up was conducted. Multivariate analysis was performed investigating which variables were independently associated with major adverse cardiac events (MACE). Patients were 64 ± 12 years old, 80 % male and 40 % had diabetes mellitus. Thromboinflammation was enhanced during index hospitalization as compared to six months follow-up (137.4 ± 100.0 µg/l vs. 53.7 ± 54.7 µg/l, p<0.001). Additionally, patients within the highest tertile of thromboinflammation at day one after STEMI showed worse outcome during follow-up (HR 2.57, CI 1.72-3.85, p<0.001). Receiver operating characteristics (ROC) analysis revealed a cut-off value of 219.3 µg/l. In multivariate logistic regression analysis, thromboinflammation was independently associated with outcome after STEMI. To sum it up, thromboinflammation is enhanced in STEMI. It identifies patients at high risk of MACE. Therefore, thromboinflammation might be a promising target and marker in precision medicine. Trial Registration Number: NCT03539133.</p>\",\"PeriodicalId\":9228,\"journal\":{\"name\":\"Blood advances\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":7.4000,\"publicationDate\":\"2024-09-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Blood advances\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1182/bloodadvances.2024014273\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"HEMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Blood advances","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1182/bloodadvances.2024014273","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"HEMATOLOGY","Score":null,"Total":0}
Thromboinflammation is associated with clinical outcome after ST-elevation myocardial infarction.
Platelets are crucial in thrombus formation during ST-elevation myocardial infarction (STEMI). In addition, they also play an important role in post-ischemic thromboinflammation which is determined by the interplay between activated platelets and neutrophils. The latter form neutrophil extracellular traps (NETs) which are detectable in plasma as citrullinated histone H3 - DNA complexes. Prediction of risk of recurrent events is important in precision medicine. Therefore, we investigated if circulating thromboinflammatory markers predict clinical outcome after STEMI. We performed a prospective, multicentric, observational, all-comer study of STEMI patients (n=361). Thromboinflammation, measured as H3Cit-DNA complexes, was assessed on day one after presentation with STEMI as well as five days and six months after STEMI by ELISA. Twelve months clinical follow-up was conducted. Multivariate analysis was performed investigating which variables were independently associated with major adverse cardiac events (MACE). Patients were 64 ± 12 years old, 80 % male and 40 % had diabetes mellitus. Thromboinflammation was enhanced during index hospitalization as compared to six months follow-up (137.4 ± 100.0 µg/l vs. 53.7 ± 54.7 µg/l, p<0.001). Additionally, patients within the highest tertile of thromboinflammation at day one after STEMI showed worse outcome during follow-up (HR 2.57, CI 1.72-3.85, p<0.001). Receiver operating characteristics (ROC) analysis revealed a cut-off value of 219.3 µg/l. In multivariate logistic regression analysis, thromboinflammation was independently associated with outcome after STEMI. To sum it up, thromboinflammation is enhanced in STEMI. It identifies patients at high risk of MACE. Therefore, thromboinflammation might be a promising target and marker in precision medicine. Trial Registration Number: NCT03539133.
期刊介绍:
Blood Advances, a semimonthly medical journal published by the American Society of Hematology, marks the first addition to the Blood family in 70 years. This peer-reviewed, online-only, open-access journal was launched under the leadership of founding editor-in-chief Robert Negrin, MD, from Stanford University Medical Center in Stanford, CA, with its inaugural issue released on November 29, 2016.
Blood Advances serves as an international platform for original articles detailing basic laboratory, translational, and clinical investigations in hematology. The journal comprehensively covers all aspects of hematology, including disorders of leukocytes (both benign and malignant), erythrocytes, platelets, hemostatic mechanisms, vascular biology, immunology, and hematologic oncology. Each article undergoes a rigorous peer-review process, with selection based on the originality of the findings, the high quality of the work presented, and the clarity of the presentation.