title: Comparative short-term prognostic value of hemostatic and inflammatory markers in patients with non-ST elevation acute coronary syndromes.
abstract: BACKGROUND
  Recent data show that markers of inflammation, endothelial perturbation as well as activation of the coagulation and fibrinolytic systems are altered in unstable angina. The purpose of this study was to compare the 30-day prognostic value of the indexes of inflammation [interleukin-6 (IL-6)], endothelial activation [von Willebrand factor antigen (vWf)], fibrinolysis [plasminogen activator inhibitor-1 (PAI-1)] and coagulation (F1 + 2), in a consecutive series of patients with non-ST elevation acute coronary syndromes.
  
  
  METHODS
  Eighty-eight patients consecutively admitted to the coronary care unit because of chest pain occurring within the previous 24 hours were included in the study. Blood was drawn on admission to the coronary care unit and 72 hours thereafter for the assessment of plasma levels of IL-6, vWf, F1 + 2 and PAI-1. Troponin I serum levels were measured 6 to 12 hours after admission. All patients underwent coronary arteriography.
  
  
  RESULTS
  Patients were divided into two groups according to their 30-day outcome: 57 patients (group 1) had an uneventful outcome, whereas 31 patients had an adverse clinical event (4 died, 1 had a Q wave myocardial infarction and 26 had refractory angina). The baseline biochemical variables were similar between group 1 and group 2 patients. Seventy-two hours following admission, an increase in the serum levels of IL-6 was observed in 71% of group 2 patients and in 28% of group 1 patients (p = 0.0001). The other measured variables showed significant changes at 72 hours versus entry only in group 1 patients, and no significant difference between the two groups. The areas under the ROC curves were higher for IL-6 (0.72) than for the other variables (0.58 for F1 + 2, 0.52 for vWf and 0.54 for PAI-1). In a multivariate model, including clinical, angiographic, and biochemical variables, only the change in IL-6 over 72 hours was significantly associated with a worse 30-day outcome (odds ratio 8.472, 95% confidence interval 1.030-69.671).
  
  
  CONCLUSIONS
  This study shows that a mounting inflammatory process, as indicated by increasing levels of IL-6 over the first 72 hours after admission, is the most powerful predictor of the 30-day prognosis in patients with non-ST elevation acute coronary syndromes.
authors.affiliation: Division of Cardiology, Hospital of Legnano, Legnano, MI, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Passoni
authors.forename: Benedetto
authors.initials: B
authors.lastname: Morelli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Seveso
authors.forename: Luisa
authors.initials: L
authors.lastname: Lazzati
authors.forename: Gabriella
authors.initials: G
authors.lastname: Beria
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Del Rosso
authors.forename: Maurizio
authors.initials: M
authors.lastname: D'Urbano
authors.forename: Francesco
authors.initials: F
authors.lastname: Cafiero
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mariani
authors.forename: Stefano
authors.initials: S
authors.lastname: De Servi
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000097:blood* / Q000503:physiopathology*; D015415:Biomarkers / Q000097:blood*; D017023:Coronary Angiography; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000503:physiopathology*; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D013997:Time Factors; D019210:Troponin I / Q000097:blood; D014841:von Willebrand Factor / Q000032:analysis
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D015850:Interleukin-6; D017395:Plasminogen Activator Inhibitor 1; D019210:Troponin I; D014841:von Willebrand Factor