Abstract 11265: Serum Soluble Tumor Necrosis Factor Receptor (sTNFR) 1 and 2 in STEMI

Introduction:Tumor necrosis factor-? (TNF-?) interacts with two soluble receptors: sTNFR1 and sTNFR2. Little is known about the role of sTNFR1 and sTNFR2 in patients with acute ST-segment elevation myocardial infarction (STEMI).Hypothesis:Our hypothesis was that the serum levels of sTNFR1 and sTNFR2 might be a marker of the severity of STEMI.Methods:We prospectively enrolled 230 consecutive STEMI patients who underwent PCI revascularization in our hospital into a prospective cohort. Blood samples were collected at 5 time points: admission, 4, 24, 48 hours and 1 month after admission (H4, H24, H48, M1). Samples were stored at -80?C. sTNFR1 and sTNFR2 serum levels were assessed using an ELISA assay. Patients underwent cardiac magnetic resonance imaging at M1 for infarct size and left ventricular ejection fraction (LVEF) assessment. Clinical outcomes from the study population were recorded over 18 months after STEMI.Results:Mean age of the study population was 59?12 years and 48.5% patients exhibited anterior STEMI. sTNFR1 level significantly increased at H24 with a median of 601.2 pg/mL (interquartile range (IQR) [397.1-896.7]). sTNFR2 level significantly increased at H48 with a median of 2262.3 pg/mL (IQR [1659.6-2862.4]). Patients with sTNFR1 and sTNFR2 peak levels greater than the population median value displayed significantly larger final infarct size and lower LVEF. sTNFR1 and sTNFR2 level were inversely correlated with LVEF recovery at one year (r=-0.52; p<0.0001 for sTNFR1 and r=-0.35; p=0.003 for sTNFR2). Patients with peak levels of sTNFR1 and sTNFR2 higher than the population median value were more likely to have an adverse clinical event (MI, stroke, hospitalization for heart failure and all-cause death) during the first 18 months after STEMI (hazard ratio (HR) at 9.0 [3.7-22.2], p=0.0003 for sTNFR1 and 5.5 [2.1-14.3], p=0.002 for sTNFR2). Patients with high level of both sTNRF1 and sTNFR2 were at higher risk of adverse clinical event when compared to patients with low level of sTNFR1 and sTNFR2 (HR = 13.1 [4.4-38.7], p=0.0005).Conclusion:High levels of circulating sTNFR1 and sTNFR2 were associated with larger infarct size, impaired recovery of LVEF and adverse clinical event in STEMI patients. sTNFR1 and 2 might be useful prognosis markers.