Markers of inflammation and haemostasis: Associations with myocardial injury, adverse remodelling and future clinical events in patients with ST-elevation myocardial infarction

In this thesis we studied patients with acute ST- elevation myocardial infarction and their relation to different circulating biomarkers reflecting activation of the inflammatory and haemostatic system and a marker associated with ischemia/reperfusion injury and remodelling. We found that a novel inflammatory marker, soluble IL-6 receptor (sIL-6R) was associated with increased risk of future cardiovascular events including new myocardial infarction, readmission for heart failure, stroke or all-cause mortality. IL-6 and C-reactive protein as well as markers of hypercoagulability were associated with larger infarcts and reduced left ventricular function. CCN2, a marker of remodelling was not related with either infarct size, left ventricular function or increased risk of new adverse events, indicating that the soluble form of this protein does not play an important role in this setting. The main conclusion is that higher levels of sIL-6R in the sub-acute phase after a STEMI are associated with adverse prognosis. Inhibition of the IL-6 receptor may be a therapeutic approach