Macrophage migration inhibitory factor as a diagnostic tool for acute coronary syndrome

Introduction

Inflammatory activity is recognizably enrolled in the physiopathological basis of acute coronary syndrome (ACS). Considering the diagnostic challenge related to ACS when typical electrocardiographic (EKG) findings are absent, we evaluated the role of migration inhibitory factor (MIF), soluble CD40 ligand (CD40L) and IL-6 in this scenario.

Design

A prospective, observational, cohort pilot study.

Setting

The emergency division at a tertiary care cardiology center.

Methods

Under informed consent, patients whose main complaint was chest pain were considered eligible. Exclusion criteria consisted of associated neoplastic, infectious or inflammatory disease as well as EKG with ST-segment elevation above 1 mm. Within the first 12 hours of admission, venous blood was sampled for sCD40L, MIF and IL-6 assays (ELISA-sandwich; R&D Systems, Minneapolis, MN, USA). A high risk for ACS was defined by nuclear image, angiographic and/or enzymatic criteria (troponin I >1.0).

Results

From 195 patients included, 69 (35.4%) were considered under high risk for ACS and 126 (64.6%) as non-ACS patients. Within the overall patients, a positive bidirectional correlation was observed between sCD40L and MIF, and a negative correlation was observed between each of these and IL-6. After principal component analysis, non-parametric tests showed significant differences between the two groups concerning levels of MIF (P < 0.0001) and IL-6 (P = 0.012). For discrimination of patients under high risk for ACS, areas under the receiver operator curves for MIF and IL-6 were 0.69 and 0.61, respectively.

Conclusion

In spite of complex interactions among inflammatory mediators, levels of MIF are independently related and possibly have a role in the identification of patients under high risk for ACS among those with chest pain without ST-segment elevation. Further studies are needed to explore MIF potential as a new diagnostic tool in ACS.