Valor prognóstico de marcadores inflamatórios relacionados à ativação de macrófagos em pacientes com síndrome coronariana aguda

Abstract

Objective: Evaluate the prognostic value of some markers related to activation of macrophages (CCL-2, IL-1 and netrin-1) in patients with Acute Coronary Syndrome (ACS) included in the Strategy of Registry of Acute Coronary Syndrome study (ERICO). Methods: We determined the concentration of CCL-2, IL-1 and netrin-1 by ELISA in serum samples of 803 patients. Data collection was conducted on cardiovascular risk factors, heart failure history and biochemical tests. The population was characterized and the prognostic value of markers was assessed at one-year and two-year follow-up. Analysis was conducted considering the median concentration of each marker to obtain the low and high CCL-2 groups, low and high IL-1 and low and high netrin-1. Results: The median age was 63 years. 58.5% of patients were men and 41.5% had NSTEMI. Hypertension, dyslipidemia, diabetes mellitus, current smoking, and previous heart failure presented frequencies of 75.5%, 47.1%, 37.9%, 28.1% and 24.4%, respectively. The median BMI was 26.8 kg/m2. We observed high blood glucose (124.5 mg/dL), low HDL (37.0 mg/dL) and high LDL (101.0 mg/dL) levels. The median concentration of CCL-2, IL-1 and netrin-1 were 100.9 pg/mL, 14.3 pg/mL, 44.8 pg/mL, respectively. The mean follow-up was 2.6 years. CCL-2 levels were not associated with prognosis in one-year follow-up. However, patients with lower CCL-2 levels had a worse prognosis in two-years follow-up with an increased risk of myocardial infarction mortality or new nonfatal myocardial infarction, even after adjusting for cardiovascular risk factors and medication. IL-1 levels were not associated with prognosis in one year and two-year follow-up. Netrin-1 above the median was associated with worse prognosis in one year and two-year follow-up (all-cause mortality), but the association was not observed after model adjustment. Conclusion: Lower CCL-2 levels and higher netrin-1 levels were associated with poor prognosis. We believe that lower concentration of CCL-2 can impair monocyte recruitment for myocardial infarction healing. This is the first study to evaluate the prognostic value of netrin-1 in patients with ACS.