{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T01:51:18Z","timestamp":1781747478164,"version":"3.54.5"},"reference-count":16,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceuticals"],"abstract":"<jats:p>Background: Inflammation plays a central role in the pathophysiology and clinical progression of acute myocardial infarction (MI). Although clopidogrel is known to exert potential anti-inflammatory effects in addition to platelet inhibition, the behavior of the early inflammatory response after treatment initiation and its prognostic significance remain unclear. This study aimed to evaluate dynamic inflammatory changes during the early post-treatment period and their association with in-hospital outcomes in patients with ST-elevation myocardial infarction. Methods: This retrospective, observational, single-center study included 300 patients with ST-elevation myocardial infarction treated with clopidogrel loading therapy. Systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), and delta neutrophil index (DNI) were evaluated before treatment and 24\u201348 h after therapy. In-hospital mortality and major adverse in-hospital outcomes were analyzed. Receiver operating characteristic analysis and multivariable logistic regression models were used to determine prognostic performance and independent predictors. Results: Contrary to the expected anti-inflammatory effect, all inflammatory markers significantly increased after clopidogrel therapy (all p &lt; 0.05). Patients with persistent or increased inflammatory response demonstrated significantly higher rates of in-hospital mortality and major adverse outcomes. Post-treatment SIRI showed the strongest predictive performance for mortality (AUC: 0.81, 95% CI: 0.75\u20130.87), followed by \u0394SIRI (AUC: 0.79). Multivariable analyses identified higher post-treatment inflammatory burden and dynamic inflammatory increases, particularly post-DNI and \u0394SIRI, as independent predictors of mortality and adverse clinical course. Conclusions: Early inflammatory activation after clopidogrel therapy is strongly associated with poor in-hospital outcomes in patients with acute myocardial infarction. Persistent or increasing inflammatory burden may reflect an uncontrolled inflammatory response despite antiplatelet treatment and may serve as a practical and powerful prognostic marker for early risk stratification.<\/jats:p>","DOI":"10.3390\/ph19060942","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:49:42Z","timestamp":1781743782000},"page":"942","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of Clopidogrel on Early Inflammatory Response and In-Hospital Outcomes in Patients with Myocardial Infarction"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2896-6934","authenticated-orcid":false,"given":"\u00d6zkan","family":"Karaca","sequence":"first","affiliation":[{"name":"Department of Cardiology, Mersin City Education and Research Hospital, 33240 Mersin, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1470-5955","authenticated-orcid":false,"given":"Burak","family":"Toprak","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Mersin City Education and Research Hospital, 33120 Mersin, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5127-8673","authenticated-orcid":false,"given":"Mustafa","family":"Ekici","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Mersin Provincial Health Directorate, 33000 Mersin, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nihat","family":"S\u00f6ylemez","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Mersin City Education and Research Hospital, 33240 Mersin, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9340-7798","authenticated-orcid":false,"given":"Ali Or\u00e7un","family":"S\u00fcrmeli","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Mersin City Education and Research Hospital, 33240 Mersin, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4724-3600","authenticated-orcid":false,"given":"Ahmet Turhan","family":"K\u0131l\u0131\u00e7","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Mersin City Education and Research Hospital, 33120 Mersin, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonay","family":"O\u011fuz","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Mersin City Education and Research Hospital, 33120 Mersin, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet","family":"Ball\u0131","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Mersin City Education and Research Hospital, 33240 Mersin, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0142-0720","authenticated-orcid":false,"given":"R\u0131dvan","family":"Bora","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Mersin City Education and Research Hospital, 33240 Mersin, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmut","family":"Y\u0131lmaz","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Mersin City Education and Research Hospital, 33240 Mersin, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4738-3478","authenticated-orcid":false,"given":"Samet","family":"Y\u0131lmaz","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ba\u015fkent University Adana Research Center, 01250 Adana, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serdar","family":"Ke\u00e7eo\u011flu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Mersin City Education and Research Hospital, 33240 Mersin, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"223","DOI":"10.21608\/aprh.2022.155725.1188","article-title":"Insight into the pathophysiology of myocardial infarction","volume":"6","author":"Elshafey","year":"2022","journal-title":"J. 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