Body temperature, systemic inflammation and risk of adverse events in patients with acute coronary syndromes

IF 4.4 3区医学 Q1 MEDICINE, GENERAL & INTERNAL European Journal of Clinical Investigation Pub Date : 2024-09-30 DOI:10.1111/eci.14314

Jan Gerrit van der Stouwe, Konstantin Godly, Simon Kraler, Julia Godly, Christian M. Matter, Florian A. Wenzl, Arnold von Eckardstein, Lorenz Räber, François Mach, Slayman Obeid, Christian Templin, Thomas F. Lüscher, David Niederseer, the SPUM-ACS investigators

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Abstract

Background

Inflammatory processes can trigger acute coronary syndromes (ACS) which may increase core body temperature (BT), a widely available low-cost marker of systemic inflammation. Herein, we aimed to delineate baseline characteristics of ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation ACS (NSTE-ACS) patients stratified by initial BT and to assess its predictive utility towards major adverse cardiovascular events (MACE) after the index ACS.

Methods

From 2012 until 2017, a total of 1044 ACS patients, 517 with STEMI and 527 with NSTE-ACS, were prospectively recruited at the University Hospital Zurich. BT was measured by digital tympanic thermometer along with high-sensitivity C-reactive protein (hs-CRP) and cardiac troponin-T (hs-cTnT) levels prior to coronary angiography. Patients were stratified according to initial BT and uni- and multivariable regression models were fit to assess associations of BT with future MACE risk.

Results

Among patients with STEMI, BT was not predictive of 1-year MACE, but a U-shaped relationship between BT and MACE risk was noted in those with NSTE-ACS (p = .029), translating into a 2.4-fold (HR, 2.44, 95% CI, 1.16–5.16) increased 1-year MACE risk in those with BT >36.8°C (reference: 36.6–36.8°C). Results remained robust in multivariable-adjusted analyses accounting for sex, age, diabetes, renal function and hs-cTnT. However, when introducing hs-CRP, the BT-MACE association did not prevail.

Conclusions

In prospectively recruited patients with ACS, initial BT shows a U-shaped relationship with 1-year MACE risk among those with NSTE-ACS, but not in those with STEMI. BT is a broadly available low-cost marker to identify ACS patients with high inflammatory burden, at high risk for recurrent ischaemic events, and thus potentially suitable for an anti-inflammatory intervention.

Registration

ClinicalTrials.gov Identifier: NCT01000701.

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急性冠状动脉综合征患者的体温、全身炎症和不良事件风险。

背景：炎症过程可诱发急性冠状动脉综合征（ACS），这可能导致核心体温（BT）升高，而核心体温是一种广泛使用的低成本全身炎症标志物。在此，我们旨在根据初始 BT 划分 ST 段抬高型心肌梗死（STEMI）和非 ST 段抬高型 ACS（NSTE-ACS）患者的基线特征，并评估其对指数 ACS 后主要不良心血管事件（MACE）的预测作用：从2012年到2017年，苏黎世大学医院共招募了1044名ACS患者，其中517名为STEMI患者，527名为NSTE-ACS患者。在冠状动脉造影术前，通过数字耳温计测量BT以及高敏C反应蛋白（hs-CRP）和心肌肌钙蛋白-T（hs-cTnT）水平。根据初始BT对患者进行分层，并拟合单变量和多变量回归模型以评估BT与未来MACE风险的关系：在 STEMI 患者中，BT 对 1 年 MACE 没有预测作用，但在 NSTE-ACS 患者中，BT 与 MACE 风险呈 U 型关系（p = 0.029），即 BT >36.8°C 的患者 1 年 MACE 风险增加 2.4 倍（HR，2.44，95% CI，1.16-5.16）（参考值：36.6-36.8°C）。在考虑性别、年龄、糖尿病、肾功能和 hs-cTnT 的多变量调整分析中，结果依然稳健。然而，当引入hs-CRP时，BT与MACE的关系并不占优势：在前瞻性招募的 ACS 患者中，初始 BT 与 NSTE-ACS 患者的 1 年 MACE 风险呈 U 型关系，但与 STEMI 患者无关。BT是一种可广泛使用的低成本标记物，可用于识别炎症负担重、复发缺血性事件风险高的ACS患者，因此可能适合进行抗炎干预：注册：ClinicalTrials.gov Identifier：注册：ClinicalTrials.gov Identifier：NCT01000701。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Clinical Investigation 医学-医学：内科

CiteScore

9.50

自引率

3.60%

发文量

192

审稿时长

1 months

期刊介绍： EJCI considers any original contribution from the most sophisticated basic molecular sciences to applied clinical and translational research and evidence-based medicine across a broad range of subspecialties. The EJCI publishes reports of high-quality research that pertain to the genetic, molecular, cellular, or physiological basis of human biology and disease, as well as research that addresses prevalence, diagnosis, course, treatment, and prevention of disease. We are primarily interested in studies directly pertinent to humans, but submission of robust in vitro and animal work is also encouraged. Interdisciplinary work and research using innovative methods and combinations of laboratory, clinical, and epidemiological methodologies and techniques is of great interest to the journal. Several categories of manuscripts (for detailed description see below) are considered: editorials, original articles (also including randomized clinical trials, systematic reviews and meta-analyses), reviews (narrative reviews), opinion articles (including debates, perspectives and commentaries); and letters to the Editor.