title: Interleukin-18/interleukin-10 ratio is an independent predictor of recurrent coronary events during a 1-year follow-up in patients with acute coronary syndrome.
abstract: BACKGROUND
  The pro-inflammatory cytokine IL-18 has been suggested to play a role in atherogenesis and atheromatous plaque rupture leading to the acute coronary syndrome (ACS). Conversely, the anti-inflammatory cytokine IL-10 seems to have an atheroprotective role. Patients with unstable coronary artery disease show an imbalance between serum levels of pro- and anti-inflammatory cytokines, and studies have shown that IL-18/IL-10 ratio is an independent predictor of adverse in-hospital events in patients with ACS. We assessed the long-term prognostic significance of admission interleukin-18 (IL-18)/interleukin-10 (IL-10) ratio for recurrent coronary events during a 1-year follow-up in patients presenting with an ACS.
  
  
  METHODS
  We assessed independent predictors of the combined end-point using multiple logistic regression analysis, in 186 patients (138 men, 65+/-12 years) with ACS (75 STEMI, 65 NSTEMI and 46 unstable angina). The composite of cardiac death and re-hospitalization with non-fatal myocardial infarction, or unstable angina, was the pre-specified study end-point. Serum IL-10 and IL-18 levels were measured at study entry using commercially available ELISAs.
  
  
  RESULTS
  During the 1-year follow-up, 48 (26%) patients had recurrent cardiac events and 138 (74%) were event-free. IL-18/IL-10 ratio predicted the occurrence of adverse cardiac events (OR 1.91, 95% CI 1.37-2.65, p<0.001), and was found to be an independent predictor among other established biochemical and clinical risk markers (OR 2.31, 95% CI 1.55-3.42, p<0.001).
  
  
  CONCLUSIONS
  Serum IL-18/IL-10 ratio is an independent predictor of recurrent coronary events during long-term follow-up in patients presenting with ACS. Our study further supports the hypothesis that the balance between pro-inflammatory and anti-inflammatory cytokines may be an important determinant of patient outcome, suggesting a pathogenic role in plaque progression and instability.
authors.affiliation: University Cardiology Clinic, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Georgios K
authors.initials: GK
authors.lastname: Chalikias
authors.forename: Dimitrios N
authors.initials: DN
authors.lastname: Tziakas
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Kaski
authors.forename: Angelos
authors.initials: A
authors.lastname: Kekes
authors.forename: Eleni I
authors.initials: EI
authors.lastname: Hatzinikolaou
authors.forename: Dimitrios A
authors.initials: DA
authors.lastname: Stakos
authors.forename: Ioannis K
authors.initials: IK
authors.lastname: Tentes
authors.forename: Alexandros X
authors.initials: AX
authors.lastname: Kortsaris
authors.forename: Dimitrios I
authors.initials: DI
authors.lastname: Hatseras
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016753:Interleukin-10 / Q000097:blood*; D020382:Interleukin-18 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood*; D011237:Predictive Value of Tests; D012008:Recurrence; D013997:Time Factors
chemical_list: D020382:Interleukin-18; D016753:Interleukin-10