Resistin and CRP as strong predictors of coronary multivessel disease in acute coronary syndrome

Abstract Introduction While the causes of acute coronary syndromes (ACSs) have been extensively studied, traditional cardiovascular risk factors do not completely explain the development and severity of ischemic heart disease in all individuals. As a result, incorporating additional biomarkers may improve the accuracy of predicting disease severity and refining risk stratification. Purpose This study aims to investigate the predictive value of inflammatory biomarkers—interleukin-1 receptor antagonist (IL-1RA), resistin, and C-reactive protein (CRP)—in assessing the severity of coronary lesions in patients with ACSs. By analyzing their association with coronary multivessel disease (MVD) using advanced imaging techniques and biomarker quantification, we seek to determine whether these markers can enhance risk stratification and improve early clinical decision-making in ACS patients. Methods We assessed the potential role of three inflammatory markers (IL-1RA, resistin and CRP) as independent markers for the severity of coronary lesions in a cohort of patients with ACSs. The inclusion criteria were ACS in the first 7 days after the acute event with at least another coronary lesion apart from the culprit estimated to have a diameter stenosis ≥40% on coronary angiography, in subjects with life expectancy of at least one year. We accessed the severity of the non-culprit coronary lesions extensively with fractional flow reserve and optical coherence tomography. Using enzyme-linked immunosorbent assays method we determined the plasmatic concentrations of biomarkers at baseline (within 48h after the ACS) and at follow-up, at 6 months. Results Out of the included 93 patients, 59.1% presented with more than one significant coronary lesion and were included in the MVD. In univariate logistic regression, the baseline levels of resistin (OR=1.952, 95% CI=1.466-2.597, p=0.001) and CRP (OR=1.831, 95% CI=1.352-2.248, p=0.008) proved to be independent predictors for coronary multivessel disease. We categorized patients into four groups based on the number of biomarkers exceeding the established cut-off values (cut-offs for CRP 1583 ng/ml, resistin 12.2 ng/ml, IL-1RA 483.8 pg/ml). A statistically significant difference was observed between the SVD and MVD concerning the number of elevated biomarkers (p0.001). Receiver Operating Characteristic curve (ROC) analysis showed that the two cytokines (AUC 0.92, p=0.001) have a better predictive value for MVD than each individual of these (CRP, AUC=0.81, p=0.004 and resistin, AUC=0.87, p=0.001). Conclusion Baseline plasma levels of resistin and CRP serve as strong individual and combined predictors of coronary multivessel disease in patients with acute coronary syndrome (ACS). Their significant association with disease severity suggests that these inflammatory biomarkers could enhance early risk stratification and aid in identifying high-risk patients who may benefit from more intensive monitoring and therapeutic interventions