Prognostic role of inflammatory status in type 2 myocardial infarction

Abstract Background there is a wealth of evidence on the importance of inflammatory status in destabilization of chronic artery plaques that led to acute myocardial infarction. However, its role in the setting of type 2 myocardial infarction (T2MI) is not yet specifically known. Purpose We investigated prognostic role of inflammatory parameters in T2MI. Methods We consecutively enrolled 461 T2MI patients from January 2017 to June 2021. T2MI was defined according to the fourth Universal Definition of Myocardial Infarction. We divided the overall population in patients who experience major cardiovascular events (MACE), n=166, and in those who do not (n=277). Receiver operating characteristic (ROC) curve analysis were used to assess the diagnostic accuracy of various inflammatory parameters for predict MACE occurrence during long term follow-up. We divided patients into two groups (high and low inflammatory burden) based on the value associated with the highest Youen index. Cox proportional hazards regression models were constructed to estimate the independent role of these parameters in predict MACE. Results We found that patients who experienced MACE had a higher level of inflammatory parameters, in particular hs-CRP (2.21±3.7 vs 1.48 ±3.5, p<0.001) and platelet-to-neutrophil ratio (3.72 ±1.52 vs 3.7±1.43, p=0.02). Using ROC analysis, the area under the curve (AUC) of hs-CRP was the largest among all inflammatory parameters and the optimal threshold, according to Youden’s index, was found to be 1.2 mg/dL. MACE-free survival curves, comparing groups with low hs-CRP (< 1.2 mg/dL) and high hs-CRP (≥ 1.2 mg/dL), showed that high hs-CRP was associated with a worse prognosis (p<0.001). At Cox regression models, hs-CRP value ≥1.2 mg/dL was independently associated with MACE (p=0.01) together with diabetes (p=0.006), chronic obstructive pulmonary disease (p=0.006), previous stroke (p=0.001) and older age (p<0.001). Conclusion T2MI patients who experienced MACE exhibited higher levels of inflammatory parameters. Patients with hs-CRP levels ≥1.2 mg/dL had a worse prognosis, independently predicting MACE. These findings underscore the potential utility of hs-CRP as a prognostic biomarker in risk-stratifying patients with T2MI and highlight the importance of addressing inflammatory status in optimizing patient management and improving outcomes.