Prognostic Value of Tumor Necrosis Factor-Alpha in Patients With ST-Segment Elevation Acute Myocardial Infarction

Introduction and objectives. Tumor necrosis factoralpha (TNFα) is implicated in a variety of inflammatory processes, including cardiovascular disease. Little is known about the prognostic value of TNFα in patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to determine the prognostic value of TNFα in this clinical setting at 6-month follow-up. Methods. The levels of TNFα, C-reactive protein (CRP), interleukin 6, and type 1 soluble intercellular adhesion molecules measured within the first 10 h of symptom onset and at 48 h in 74 consecutive patients admitted with STEMI. The relationships between these levels and the incidence of ischemic events (ie, angina, reinfarction, and death), heart failure (HF), or both (ie, all cardiovascular events) were studied. Results. Overall, TNFα levels were significantly higher in patients who had an ischemic event or HF than in those who did not (P<.02 for both). At 48 h, the adjusted odds ratios of those in the highest TNFα quartile (2.92 pg/mL) for the development of ischemic events, HF, and all cardiovascular events combined were 13.1, 9.59, and 9.75, respectively. A TNFα level of 2.04 pg/mL at 48 h had a sensitivity of 78% and a specificity of 72.5% in predicting a cardiovascular event of any form. The CRP level, but not the TNFα level, at admission was found to be an independent predictor of the development of a cardiovascular events.