Original article Inflammatory markers and cardiac function in acute coronary syndrome: Difference in ST-segment elevation myocardial infarction (STEMI) and in non-STEMI models Rossella Di Stefano a, * , Vitantonio Di Bello b , Maria Chiara Barsotti a , Chrysanthos Grigoratos c , Chiara Armani a , Matteo Dell’Omodarme d , Angelo Carpi e , Alberto Balbarini c a Cardiovascular Research Laboratory, Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy b Cardiac Ultrasound Laboratory, Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy c Angiology Unit, Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy d Classe di Scienze, Scuola Normale Superiore, INFN, Pisa, Italy e Department of Reproduction and Ageing, University of Pisa, Pisa, Italy Received 26 May 2009; accepted 7 June 2009 Available online 13 October 2009 Abstract Purpose: No studies have been addressed to the differences in inflammation kinetics between ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). Patients and methods: Forty consecutive patients with acute coronary syndrome (ACS) (n ¼ 23 STEMI, age ¼ 61.7  10.3 years; n ¼ 17 NSTEMI, age ¼ 65.6  11.3 years) were enrolled within 12 h after symptoms. All patients received therapy according to the current Guidelines. Blood samples were collected at admission (t0), on days 7 (t1) and 30 (t2) to evaluate CD40 ligand (CD40L), transforming growth factor (TGF)-beta, interleukin (IL)-6, tumor necrosis factor (TNF)-alpha and its receptors TNFRI and TNFRII, high sensitivity C-reactive protein (hs- CRP), serum amyloid A (SAA) and white blood cells (WBC). Echocardiographic parameters were also evaluated. Results: STEMI patients, at admission, had significantly higher median values of hs-CRP ( p < 0.001), WBC ( p < 0.01), ferritin ( p < 0.0005) and IL-6 ( p < 0.05) than NSTEMI. On the contrary, NSTEMI patients had lower median levels of every inflammatory marker except for CD40L ( p < 0.05) that was significantly higher. Moreover, three out of four deceased patients presented levels of CD40L higher than the median. At admission, STEMI showed a reduced ejection fraction (EF, p < 0.01) and increased wall motion score index (WMSI, p < 0.001) and end- diastolic volume (EDV, p < 0.05) vs NSTEMI. An inverse correlation between admission values of inflammatory markers (SAA and WBC) and cardiac function was observed ( p < 0.05). Moreover, the necrosis marker troponin I was positively correlated with both WMSI ( p < 0.05) and hs-CRP ( p < 0.05). Regarding the inflammation kinetics, a difference was observed in the two groups only for WBC ( p < 0.05) and SAA ( p < 0.05). SAA showed higher values in STEMI at t0 and t1. In both groups, TGF-beta had an increase at t1 and t2 with respect to admission, while IL-6 had a decreasing trend. The total incidence of major adverse clinical events (MACE) was 22.5% at t2, with a mortality rate of 10%. Conclusion: These observations suggest a differential inflammatory pattern in STEMI and NSTEMI patients. The absence of significant correlations between inflammatory indexes and myocardial infarction in NSTEMI supports the hypothesis that a different pattern of inflam- mation occurs in these patients. CD40L may have an important role as a marker for risk stratification in patients with ACS. Ó 2009 Elsevier Masson SAS. All rights reserved. Keywords: Inflammatory biomarkers; STEMI; NSTEMI; Acute coronary syndrome * Corresponding author at: Cardiovascular Research Laboratory, Cardiac, Thoracic and Vascular Department, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy. Tel./fax: þ39 050 995 755. E-mail address: r.distefano@ao-pisa.toscana.it (R. Di Stefano). 0753-3322/$ - see front matter Ó 2009 Elsevier Masson SAS. All rights reserved. doi:10.1016/j.biopha.2009.06.004 Available online at www.sciencedirect.com Biomedicine & Pharmacotherapy 63 (2009) 773e780