Arq. Bras. Cardiol. 2022; 119(1): 23-24
A New Risk Predictor in Acute Myocardial Infarction. Is There Still Room for One More?
This Short Editorial is referred by the Research article "Systemic Immune-Inflammation Index Predicts Major Cardiovascular Adverse Events in Patients with ST-Segment Elevated Myocardial Infarction".
Cardiology is one of the specialties that traditionally uses scientific evidence in daily practice, both in risk stratification and diagnosis, therapy and prognosis. One of the most discussed topics is atherosclerosis and inflammation, arousing great interest in the continuous knowledge acquired over the last two centuries. Several authors stand out in this historical context, for example, Rudolf Virchow in the 19th century who described the association of atherosclerosis with inflammation; Marchand in 1904, who suggested the relationship between atherosclerosis and the process of clogging of the arteries and in 1908, Ignatowski who observed the relationship between dietary cholesterol and atherosclerosis. Over the last 100 years, many articles have elucidated the pathophysiological sequence that we know today. Understanding atherosclerotic plaque formation and evolution through complex molecular mechanisms and innate and adaptive immunity, which culminate in acute myocardial infarction (AMI), is well established.– In 1974, Friedman GD et al., described the role of leukocyte count in the prognosis of AMI, and subsequently, other studies highlighted the importance of these cells in the deterioration and recovery of infarcted myocardium.– In the same line of investigation, Coste MER et al. investigated cytokines in patients with ST-segment elevation myocardial infarction (STEMI) and the relationship with ventricular function. They observed a balance of pro-inflammatory and anti-inflammatory cytokines, except for IL-6, suggesting a residual inflammatory risk.
In addition to these aspects related to atherosclerotic plaque and inflammatory activity in AMI, another process related to these so-called immuno-inflammatory cells, such as platelets, leukocytes, neutrophils, and lymphocytes, initially gained prominence in the field of oncology when described as a reliable prognostic marker in the progression of various malignant tumors, by the so-called “systemic immuno-inflammation index” (IIIS). The systematic review and meta-analysis by Zhong et al. emphasize the importance of this index in predicting survival since high rates were associated with a worse prognosis in solid tumors. In addition to neoplasms, other factors alter IIIS, such as age, obesity, type 2 diabetes, emotional stress, exogenous steroids, endogenous sex hormones, hematological disorders, stroke, pulmonary embolism, and trauma.
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