The impact of hs C-reactive protein and other inflammatory biomarkers on long-term cardiovascular mortality in patients with acute coronary syndromes.
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.
Zairis
Michael N
MN
Department of Cardiology, Tzanio Hospital, Piraeus, Greece. zairis@hellasnet.gr
Adamopoulou
Evdokia N
EN
Manousakis
Stavros J
SJ
Lyras
Anastassios G
AG
Bibis
George P
GP
Ampartzidou
Olga S
OS
Apostolatos
Charalambos S
CS
Anastassiadis
Filippos A
FA
Hatzisavvas
John J
JJ
Argyrakis
Spyros K
SK
Foussas
Stefanos G
SG
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
D015415:Biomarkers; D015850:Interleukin-6; D000685:Serum Amyloid A Protein; D005340:Fibrinogen; D002097:C-Reactive Protein