High admission levels of interleukin-1 receptor antagonist in acute myocardial infarction patients are associated with increased rates of all-cause mortality and cardiac death at five years follow-up

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BACKGROUND: Inflammation including activation of the interleukin (IL)-1-related pathway is involved in the pathogenesis of coronary heart disease. The effects of IL-1 are modulated by several soluble molecules such as IL-1 receptor antagonist (IL-1RA), IL-1R type 2 (IL-1R2) and IL-1 receptor accessory protein (IL-1RAcP). We hypothesize that levels of these IL-1 modulators, potentially reflecting IL-1 activity, will yield prognostic information in patients with acute myocardial infarction (AMI). AIM: To assess the prognostic utility of IL-1RA, IL-1R2 and IL-1RAcP in AMI patients. METHODS: -transformed values, were fitted for the biomarkers with all-cause and cardiac death within 5 years as the dependent variables. The hazard ratio (HR) (95 % CI) was assessed in univariate and multivariable models, adjusting for traditional risk factors, including B-type natriuretic peptide and high sensitivity C-reactive protein. RESULTS: By 5 years all-cause and cardiac mortality were recorded in 91 (25.1 %) and 49 (15.2 %) patients, respectively. For IL-1RA, death rates increased significantly from Q1 to Q4. Comparing Q4 with Q1 and using continuous values, IL-1RA was significantly associated with both events in univariate and adjusted models at 2- and 5 years follow-up. In adjusted analysis, IL-1R2 was associated with cardiac mortality, but only when assessed as a continuous variable. IL-1RAcP gave no prognostic information. CONCLUSION: High admission levels of IL-1RA were independently associated with increased 2- and 5 years mortality in patients with AMI.

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