title: The impact of hs C-reactive protein and other inflammatory biomarkers on long-term cardiovascular mortality in patients with acute coronary syndromes.
abstract: We evaluated whether high circulating levels of serum amyloid A (SAA), fibrinogen, interleukin-6 (IL-6) or leukocytes count (LC), can provide any additional predictive value over that provided by hs C-reactive protein (hs-CRP) for the incidence of 5-year cardiovascular mortality, in 458 and 476 consecutive patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndromes (NSTE-ACS), respectively. By 5 years the incidence of cardiovascular mortality was 37.3% and 35.5% in patients with STEMI and NSTE-ACS, respectively. Each of the study inflammatory biomarkers conferred independent to clinical risk predictors (and to cardiac troponin I) long-term prognostic information (all p<0.05), but only LC provided additional predictive value over that provided by hs-CRP, in either cohort (p<0.05). By multivariate Cox regression analysis, hs-CRP (p<0.001 for both cohorts) and LC (p=0.009 and p<0.001 for STEMI and NSTE-ACS, respectively) were the only inflammatory biomarkers independently associated with the incidence of 5-year cardiovascular mortality. According to the present results high circulating levels of LC but not of SAA, fibrinogen or IL-6 can provide additional long-term predictive value over that provided by hs-CRP in patients with acute coronary syndromes.
authors.affiliation: Department of Cardiology, Tzanio Hospital, Piraeus, Greece. zairis@hellasnet.gr
authors.forename: Michael N
authors.initials: MN
authors.lastname: Zairis
authors.forename: Evdokia N
authors.initials: EN
authors.lastname: Adamopoulou
authors.forename: Stavros J
authors.initials: SJ
authors.lastname: Manousakis
authors.forename: Anastassios G
authors.initials: AG
authors.lastname: Lyras
authors.forename: George P
authors.initials: GP
authors.lastname: Bibis
authors.forename: Olga S
authors.initials: OS
authors.lastname: Ampartzidou
authors.forename: Charalambos S
authors.initials: CS
authors.lastname: Apostolatos
authors.forename: Filippos A
authors.initials: FA
authors.lastname: Anastassiadis
authors.forename: John J
authors.initials: JJ
authors.lastname: Hatzisavvas
authors.forename: Spyros K
authors.initials: SK
authors.lastname: Argyrakis
authors.forename: Stefanos G
authors.initials: SG
authors.lastname: Foussas
mesh_terms: D054058:Acute Coronary Syndrome / Q000276:immunology* / Q000401:mortality*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006115:Greece / Q000453:epidemiology; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D007958:Leukocyte Count; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D000685:Serum Amyloid A Protein / Q000032:analysis
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D000685:Serum Amyloid A Protein; D005340:Fibrinogen; D002097:C-Reactive Protein