Marcadores inflamatorios y riesgo de recurrencia del Ictus isquémico

En el numero de Febrero del Journal of Neurology se publican los resultados del estudio MITICO en el que han participado varias ( 65) unidades de Ictus y unidades de neurologia de Hospitales españoles. El objetivo de la investigacion ha sido el valor pronóstico de los marcadores inflamatorios en la recurrencia del ictus isquémico. Para ello se reclutaron 965 pacientes de 65 hospitales españoles. Se obtuvieron muestras en el periodo posterior a un ictus isquemico ( 1-3 meses ) de proteína C reactiva , IL-6, IL-10, ICAM-1, VCAM- 1, MMP-9 y fibronectina celular. Fueron seguidos hasta un año después para determinar la presencvia de un evento vascular durante ese periodo.En los 780 pacientes en los que se pudieron analizar los datos se prsentaron en un 13,2% un eventos vascular adversos y en el 14,9% un evento adverso o muerte de origen vascular ( 66,4% ictus, 21% evento coronario y en el 12,1% un evento relacionado con arteriopatía periférica) . Los autores concluyen que los valores basales de Interleucina 6 mayores de 5 pg/ml y los de VCAM-1 mayores de 1350 ng/ mL iincrementan 21-veces y 4-veces respectivamente el riesgo de un nuevo efectos adverso vascular o muerte de este origen en los pacientes con ictus isquémico que no reciben terapia anticoagulante.


Inflammation markers and prediction of post-stroke vascular disease recurrence: The MITICO study. Castillo J, Alvarez-Sabín J, Martínez-Vila E, Montaner J, Sobrino T, Vivancos J; on behalf of the MÍTICO Study Investigators*. Dept. of Neurology, Clinical Neuroscience Research Laboratory, Hospital Clínico Universitario, 15706 Santiago de Compostela, A Coruña, Spain,

OBJECTIVE : Vascular disease recurrence following stroke is the main cause of morbidity and mortality. The MITICO study was designed to assess the prognostic value of markers of inflammation in relation to the risk of recurrence of vascular disease. PATIENTS AND METHODS : Multi-centered prospective observational study, in patients with ischemic stroke not receiving anti-coagulation therapy and who were recruited within 1-3 months from stroke onset. Blood samples were obtained at baseline and follow- up for the determination of high-sensitive C reactive protein (CRP), IL-6, IL-10, ICAM-1, VCAM- 1, MMP-9 and cellular fibronectin. Four follow-up visits within the first year were to rule out recurrence. RESULTS : Of 965 patients from 65 hospitals, 780 (aged 67.5+/-11.2 years, 33.6 % female) were valid for main analysis. One-hundred and three patients (13.2 %) had a new adverse vascular event and 116 patients (14.9 %) a vascular event or vascular death (66.4 % stroke, 21.5 % coronary and 12.1 % peripheral). Levels of IL-6 > 5 pg/mL and VCAM-1 > 1350 ng/mL (ROC curve analyses) were associated with vascular disease recurrence risk (OR: 28.7; 95 % CI: 14.2-58.0 vs. OR: 4.1; 95 % CI: 2.4-7.1, respectively) following adjustment for confounding variables. Risk of adverse vascular event or death from vascular disease were associated with IL-6 (OR: 21.2; 95 % CI: 11.6-38.7) and VCAM-1 (OR: 3.8; 95 % CI: 2.3-6.4). CONCLUSIONS : Baseline values of IL-6 > 5 pg/mL and VCAM-1 > 1350 ng/ mL increase 21-fold and 4-fold, respectively, the risk of new vascular disease event or death from vascular disease in patients with ischemic stroke not receiving anti-coagulation treatment.