Elevated day 1 levels of CRP, IL-6, and ICAM-1 independently predicted long-term mortality (CRP HR 1.3; 95% CI 1.1-1.5; P=0.003) and heart failure in patients with acute coronary syndromes.
Cohort (n=757)
No
Do inflammatory markers (CRP, IL-6, sPLA2-IIA, ICAM-1) predict late mortality and rehospitalization for MI or CHF in patients with acute coronary syndromes?
Elevated levels of CRP, IL-6, and ICAM-1 at day 1 of ACS admission provide independent prognostic information for long-term mortality and heart failure rehospitalization.
Effect estimate: HR 1.3 (95% CI 1.1-1.5)
p-value: p=0.003
OBJECTIVE: We investigated whether levels of C-reactive protein (CRP), interleukin-6 (IL-6), secretory phospholipase A(2) group IIA (sPLA(2)-IIA) and intercellular adhesion molecule-1 (ICAM-I) predict late outcomes in patients with acute coronary syndromes (ACS). DESIGN: Prospective longitudinal study. CRP (mg L(-1)), IL-6 (pg mL(-1)), sPLA(2)-IIA (ng mL(-1)) and ICAM-1 (ng mL(-1)) were measured at days 1 (n = 757) and 4 (n = 533) after hospital admission for ACS. Their relations to mortality and rehospitalization for myocardial infarction (MI) and congestive heart failure (CHF) were determined. SETTING: Coronary Care Unit at Sahlgrenska University Hospital, Gothenburg, Sweden. SUBJECTS: Patients with ACS alive at day 30; median follow-up 75 months. RESULTS: Survival was related to day 1 levels of all markers. After adjustment for confounders, CRP, IL-6 and ICAM-1, but not sPLA(2)-IIA, independently predicted mortality and rehospitalization for CHF. For CRP, the hazard ratio (HR) was 1.3 for mortality (95% confidence interval (CI): 1.1-1.5, P = 0.003) and 1.4 for CHF (95% CI: 1.1-1.9, P = 0.006). For IL-6, HR was 1.3 for mortality (95% CI: 1.1-1.6, P < 0.001) and 1.4 for CHF (95% CI: 1.1-1.8, P = 0.02). For ICAM-1, HR was 1.2 for mortality (95% CI: 1.0-1.4, P = 0.04) and 1.3 for CHF (95% CI: 1.0-1.7, P = 0.03). No marker predicted MI. Marker levels on day 4 provided no additional predictive value. CONCLUSIONS: In patients with ACS, CRP, IL-6, sPLA(2)-IIA and ICAM-1 are associated with long-term mortality and CHF, but not reinfarction. CRP, IL-6 and ICAM-1 provide prognostic information beyond that obtained by clinical variables.
Hartford et al. (Mon,) conducted a cohort in acute coronary syndromes (ACS) (n=757). CRP, IL-6, sPLA2-IIA, and ICAM-1 measurement was evaluated on mortality (HR 1.3, 95% CI 1.1-1.5, p=0.003). Elevated day 1 levels of CRP, IL-6, and ICAM-1 independently predicted long-term mortality (CRP HR 1.3; 95% CI 1.1-1.5; P=0.003) and heart failure in patients with acute coronary syndromes.