Prognostic significance of interleukin-6 measurement in the diagnosis of acute myocardial infarction in emergency department.
BACKGROUND
Markers of inflammation may predict both coronary artery disease (CAD) and adverse outcomes in patients with known CAD. Here, we investigated the role of interleukin-6 (IL-6) in the "triage" and risk assessment of patients admitted to emergency department (ED).


METHODS
Serum IL-6 and high sensitivity C-reactive protein (hs-CRP) levels were prospectively evaluated in 88 patients with a history of precordial chest pain or shortness of breath of recent onset (<6 h).


RESULTS
Of the 88 patients, 21% were discharged from the ED with diagnosis of non-ischemic chest pain (NICP), 39% had a final diagnosis of unstable angina (UA) and 40% experienced an acute myocardial infarction (AMI). Median IL-6 (p<0.001) and hs-CRP (p<0.01) levels on admission were significantly increased in patients with AMI compared with patients with NICP or UA. IL-6 levels correlated with hs-CRP (p<0.01). Multivariate analyses including known risk factors showed that elevated creatine kinase-MB (p<0.05) and IL-6 levels (p<0.01) were independently associated with a final diagnosis of AMI. Elevated IL-6 levels significantly predicted the risk of AMI (OR=2.47, p=0.006) in chest pain-enzyme negative patients.


CONCLUSIONS
IL-6 may behave as an adjunctive diagnostic tool to assist in the risk assessment of enzyme-negative patients with precordial chest pain of recent onset.
Ferroni
Patrizia
P
Department of Laboratory Medicine & Advanced Biotechnologies, IRCCS San Raffaele Pisana, Rome, Italy. patrizia.ferroni@sanraffaele.it
Rosa
Antonello
A
Di Franco
Manuela
M
Palmirotta
Raffaele
R
Guadagni
Fiorella
F
Davì
Giovanni
G
Bertazzoni
Giuliano
G
Basili
Stefania
S
D000208:Acute Disease; D000210:Acute-Phase Reaction / Q000097:blood; D000368:Aged; D000789:Angina, Unstable / Q000175:diagnosis / Q000209:etiology; D015415:Biomarkers; D002097:C-Reactive Protein / Q000378:metabolism; D002637:Chest Pain / Q000175:diagnosis / Q000209:etiology; D052279:Creatine Kinase, MB Form / Q000032:analysis; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D008099:Liver / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality*; D009211:Myoglobin / Q000097:blood; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012044:Regression Analysis; D018570:Risk Assessment; D019210:Troponin I / Q000097:blood
D015415:Biomarkers; D015850:Interleukin-6; D009211:Myoglobin; D019210:Troponin I; D002097:C-Reactive Protein; D052279:Creatine Kinase, MB Form