Key result
Higher admission IL-1β in STEMI linked to ~47% greater 90-day mortality per SD.
Why the study?
Although IL-1β inhibition reduces recurrent cardiovascular events in stable post-MI patients with elevated hs-CRP, its association with mortality in acute STEMI undergoing primary PCI remained unclear.
Cohort (n=1,398)
Hazard Ratio: 1.47 (95% CI 1.16–1.87)
p-value: p=<0.002
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Unopposed IL-1β activity has been associated with impaired cardiac healing and cardiac rupture post-MI in murine studies. It has additionally been associated with the development and growth of atherosclerotic plaques, impaired vasodilation, increased oxidative stress, predisposition to atherothrombosis, plaque instability and rupture, and excess mortality post-MI.”
Elevated IL-1β concentration at admission in STEMI patients undergoing primary PCI is an independent predictor of premature all-cause mortality and recurrent MACE at 90 days and 1 year.
BACKGROUND Inhibition of the interleukin-1β (IL-1β) innate immunity pathway is associated with anti-inflammatory effects and a reduced risk of recurrent cardiovascular events in stable patients with previous myocardial infarction (MI) and elevated high sensitivity C-reactive protein (hs-CRP). OBJECTIVES to assess the association between IL-1β level with all-cause mortality in patients with acute ST segment elevation myocardial infarction (MI) undergoing primary percutaneous coronary intervention and the interplay between IL-1β and hs-CRP concentrations on the risk of premature death. METHODS IL-1β concentration was measured among 1398 ST segment elevation MI patients enrolled in a prospective cohort. Crude and hazard ratios for all-cause and cardiovascular mortality were analyzed at 90-days and one-year using a multivariate-cox proportional regression analysis. Major cardiovascular events (MACE) were analyzed. RESULTS IL-1β concentration measured at admission was associated with all-cause mortality at 90 days (adjusted hazard ratio [adjHR], 1.47 per 1SD increase; 95% CI, 1.16 to 1.87; p<0.002). The relation was nonlinear, and highest tertile of IL-1β was associated with higher mortality rates at 90 days (adjHR: 2.78; 95%CI: 1.61-4.79, p=0.0002) and one-year (adjHR: 1.93; 95%CI: 1.21-3.06, p=0.005), regardless of the hs-CRP concentration. Significant relationships were equally observed when considering cardiovascular mortality and MACE at 90 days (adjHR: 2.42; 95% CI: 1.36-4.28, p=0.002 and 2.29; 95% CI: 1.31-4.01, p=0.004, respectively) and at one year (adjHR: 2.32; 95% CI: 1.36-3.97, p=0.002 and 2.35; 95% CI: 1.39-3.96, p=0.001, respectively). CONCLUSION IL-1β measured at admission in acute MI patients is independently associated with the risk of mortality and recurrent MACE. CONDENSED ABSTRACT In this observational prospective cohort study that included 1398 patients with ST segment elevation myocardial infarction, IL-1β concentration measured at admission was independently associated with all-cause mortality (adjusted hazard ratio [adjHR], 1.47 per 1SD increase; 95% CI, 1.16 to 1.87; p<0.002) and major cardiovascular event at 90 days and one year. The relation was nonlinear, and highest tertile of IL-1β was markedly associated with higher mortality rates at 90 days (adjHR: 2.78; 95%CI: 1.61-4.79, p=0.0002) and one-year (adjHR: 1.93; 95%CI: 1.21-3.06, p=0.005), regardless of the hs-CRP concentration.
No takes yet. Share an insight, caveat, or question.
Silvain et al. (2020) conducted a cohort in ST segment elevation myocardial infarction (n=1,398). IL-1β concentration was evaluated on all-cause mortality at 90 days (HR 1.47, 95% CI 1.16-1.87, p=<0.002). Higher IL-1β concentration at admission in patients with ST-segment elevation MI was associated with increased all-cause mortality at 90 days (adjHR 1.47 per 1SD increase; 95% CI 1.16-1.87; p<0.002).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: