Aims Little is known about the clinical relevance of interleukin (IL)-6 in patients with acute ST-elevation myocardial infarction (STEMI). This study examined the possible associations of plasma IL-6 concentrations with infarct size (IS), reperfusion injury and adverse left ventricular remodelling (LVR), in STEMI patients treated with primary percutaneous coronary intervention (PCI). Methods and results We prospectively included 170 consecutive STEMI patients (median age 57 years, 14% women) treated with primary PCI between 2017 and 2019. Blood samples for biomarker analyses including IL-6 were collected on Day 2. Left ventricular ejection fraction (LVEF), IS, and reperfusion injury [microvascular obstruction (MVO) and intramyocardial haemorrhage (IMH)] were determined using cardiac magnetic resonance (CMR) imaging on Day 4. Left ventricular remodelling was defined as ≥10% increase in left ventricular end-diastolic volume from baseline to 4 months CMR follow-up. Patients with IL-6 concentrations ≥median (17 ng/L) showed a significantly lower LVEF (43% vs. 52%, P < 0.001), larger IS (22% vs. 13%, P < 0.001), larger MVO (1.9% vs. 0.0%, P < 0.001), and more frequent IMH (52% vs. 18%, P < 0.001). Left ventricular remodelling was more common in patients with IL-6 ≥ median (24% vs. 9%, P = 0.005). In both linear and binary multivariable regression analyses, IL-6 remained independently associated with lower LVEF [odds ratio (OR): 0.10, 95% confidence interval (CI) 0.02–0.42, P = 0.002], larger IS (OR: 5.29, 95% CI 1.52–18.40, P = 0.009), larger MVO (OR: 5.20, 95% CI 1.30–20.85, P = 0.020), with presence of IMH (OR: 3.73, 95% CI 1.27–10.99, P = 0.017), and adverse LVR (OR: 2.72, 95% 1.06–6.98, P = 0.038). Conclusions High concentrations of circulating plasma IL-6 on Day 2 after STEMI were independently associated with worse myocardial function, larger infarct extent, more severe reperfusion injury, and a higher likelihood for LVR, suggesting IL-6 as a useful biomarker of more serious outcome and potential therapeutic target. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT04113356;NCT04113356.

中文翻译：

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ST 段抬高型心肌梗死后血浆白细胞介素 6 与梗死面积、再灌注损伤和不良重构的关系

目的 关于白细胞介素 (IL)-6 在急性 ST 段抬高心肌梗死 (STEMI) 患者中的临床相关性知之甚少。本研究检查了在接受初次经皮冠状动脉介入治疗 (PCI) 治疗的 STEMI 患者中血浆 IL-6 浓度与梗死面积 (IS)、再灌注损伤和不良左心室重构 (LVR) 的可能关联。方法和结果 我们前瞻性地纳入了 2017 年至 2019 年间接受直接 PCI 治疗的 170 名连续 STEMI 患者（中位年龄 57 岁，14% 为女性）。在第 2 天收集用于生物标志物分析的血液样本，包括 IL-6。左心室射血分数 (LVEF) )、IS 和再灌注损伤 [微血管阻塞 (MVO) 和心肌内出血 (IMH)] 在第 4 天使用心脏磁共振 (CMR) 成像确定。左心室重构定义为左心室舒张末期容积从基线到 4 个月 CMR 随访增加≥10%。IL-6 浓度≥中位数 (17 ng/L) 的患者显示出显着较低的 LVEF（43% 对 52%，P < 0.001），更大的 IS（22% 对 13%，P < 0.001），更大MVO（1.9% 对 0.0%，P < 0.001）和更频繁的 IMH（52% 对 18%，P < 0.001）。左心室重构在 IL-6 ≥ 中位数的患者中更为常见（24% 对 9%，P = 0.005）。在线性和二元多变量回归分析中，IL-6 与较低的 LVEF [优势比 (OR): 0.10, 95% 置信区间 (CI) 0.02–0.42, P = 0.002]、较大的 IS (OR: 5.29, 95% CI 1.52–18.40, P = 0.009)，更大的 MVO (OR: 5.20, 95% CI 1.30–20.85, P = 0.020)，存在 IMH (OR: 3.73, 95% CI 1.27–10.99, P = 0 . 017) 和不良 LVR (OR: 2.72, 95% 1.06–6.98, P = 0.038)。结论 STEMI 后第 2 天高浓度循环血浆 IL-6 与心肌功能更差、梗死范围更大、再灌注损伤更严重和 LVR 的可能性更高独立相关，提示 IL-6 作为更严重结果的有用生物标志物和潜在的治疗靶点。临床试验注册 https://clinicaltrials.gov/ct2/show/NCT04113356;NCT04113356。