In-hospital outcome of patients with acute coronary syndrome: relationship with inflammation and remodeling markers.
OBJECTIVE
The present study was designed to evaluate the role of some inflammation [interleukin (IL)-1beta, soluble IL-1 receptor, IL-1 receptor antagonist (IL-1RA), high-sensitivity C-reactive protein (hsCRP) and fibrinogen], and remodeling markers [matrix metalloproteinase (MMP)-9, tissue inhibitor of metalloproteinase (TIMP)-1 and TIMP-2] in patients with acute coronary syndrome (ACS; 40 patients), or chronic stable angina (CSA; 40 patients) compared to age- and sex-matched healthy controls (20 subjects).


RESULTS
IL-1RA, hsCRP, fibrinogen, MMP-9, and TIMP-1 plasma levels were significantly higher in patients than in controls, whereas soluble IL-1 receptor had an opposite pattern. Among patients with ACS, hsCRP plasma levels were higher in patients with non-ST segment elevation myocardial infarction (NSTEMI) than in those with unstable angina (UA). TIMP-1 plasma levels were higher in those patients with ACS who did not respond to medical therapy (non-responsive unstable angina; NR-UA). A CRP plasma level higher than 0.86 mg/dl had a 91% positive predictive value (PPV) and 63% negative predictive value for NSTEMI (odds ratio = 6.4, 95% confidence interval = 1.5-27.4). TIMP-1 plasma level higher than 21.5 ng/ml had a 100% PPV for patients with NR-UA or NSTEMI. Binary logistic analysis confirmed TIMP-1 levels as being able to predict responsiveness to therapy.


CONCLUSIONS
In conclusion, a different biochemical pattern characterizes ACS patients: those with NR-UA show only an increase of remodeling markers, whereas ACS patients with NSTEMI have an increase of both remodeling and inflammation markers.
U.C.O. Clinica Medica Generale e Terapia Medica Dipartimento di Scienze Cliniche, Morfologiche e Tecnologiche, Università degli Studi di Trieste, Strada di Fiume 447, 34149 Trieste, Italy. giansant@units.it
Carlo
C
Giansante
Nicola
N
Fiotti
Antonio
A
Di Chiara
Nicola
N
Altamura
Stella
S
Wasserman
Paolo
P
Fioretti
Gianfranco
G
Guarnieri
D000208:Acute Disease; D000368:Aged; D000787:Angina Pectoris / Q000097:blood* / Q000503:physiopathology / Q000628:therapy; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism; D002908:Chronic Disease; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000503:physiopathology / Q000628:therapy; D053590:Interleukin 1 Receptor Antagonist Protein / Q000097:blood; D053583:Interleukin-1beta / Q000097:blood; D008297:Male; D020780:Matrix Metalloproteinase 9 / Q000378:metabolism; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood* / Q000503:physiopathology / Q000628:therapy; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D017472:Receptors, Interleukin-1 / Q000097:blood; D015203:Reproducibility of Results; D012107:Research Design; D012680:Sensitivity and Specificity; D013577:Syndrome; D019715:Tissue Inhibitor of Metalloproteinase-1 / Q000097:blood; D019716:Tissue Inhibitor of Metalloproteinase-2 / Q000097:blood; D016896:Treatment Outcome; D020257:Ventricular Remodeling
D015415:Biomarkers; D053590:Interleukin 1 Receptor Antagonist Protein; D053583:Interleukin-1beta; D017472:Receptors, Interleukin-1; D019715:Tissue Inhibitor of Metalloproteinase-1; D019716:Tissue Inhibitor of Metalloproteinase-2; D005340:Fibrinogen; D002097:C-Reactive Protein; D020780:Matrix Metalloproteinase 9