title: Additive prognostic value of interleukin-6 at peak phase of dobutamine stress echocardiography in patients with coronary artery disease. A 6-year follow-up study.
abstract: BACKGROUND
  Interleukin-6 (IL-6) and tissue factor (TF) are elevated after myocardial ischemia during dobutamine stress echo (DSE). We examined the incremental prognostic value of IL-6 or TF measured during DSE over echocardiographic and clinical factors in patients with chronic coronary artery disease (CAD).
  
  
  METHODS
  We studied 106 patients with angiographically documented CAD. IL-6 and TF were measured at rest, peak, and during recovery. A wall motion score index was calculated.
  
  
  RESULTS
  Fifty-seven (54%) patients had ischemia at DSE. During follow-up (63.7 +/- 20 months), 36 patients (33%) had an adverse event (12 cardiac deaths, 24 acute coronary events). Patients with events had a higher peak IL-6 (P = .02) but similar rest and recovery IL-6 than those without. Patients with peak IL-6 > or =3.14 pg/mL (upper tertile) had a hazard ratio of 2.7 (95% CI 1.44-5.37) (P < .01 for an adverse event). The addition of peak wall motion score index in a multivariable model including risk factors, ejection fraction, revascularization, and multivessel disease increased the model's c statistic from 0.66 to 0.70 (P = .04). The addition of peak IL-6 further increased the model's c statistic to 0.75 (P = .04). Tissue factor was not related with cardiac events.
  
  
  CONCLUSIONS
  Interleuikin-6 levels measured during the peak phase of DSE incrementally contribute to risk stratification in patients with chronic CAD.
authors.affiliation: 2nd Cardiology Department, Attikon Hospital, University of Athens, Athens, Greece. ignoik@otenet.gr
authors.forename: Ignatios
authors.initials: I
authors.lastname: Ikonomidis
authors.forename: George
authors.initials: G
authors.lastname: Athanassopoulos
authors.forename: Kimon
authors.initials: K
authors.lastname: Stamatelopoulos
authors.forename: John
authors.initials: J
authors.lastname: Lekakis
authors.forename: Ioanna
authors.initials: I
authors.lastname: Revela
authors.forename: Kiriaki
authors.initials: K
authors.lastname: Venetsanou
authors.forename: Margarita
authors.initials: M
authors.lastname: Marinou
authors.forename: Claudia
authors.initials: C
authors.lastname: Monaco
authors.forename: Dennis V
authors.initials: DV
authors.lastname: Cokkinos
authors.forename: Petros
authors.initials: P
authors.lastname: Nihoyannopoulos
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization; D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D025401:Echocardiography, Stress; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D013925:Thromboplastin / Q000032:analysis*
chemical_list: D015850:Interleukin-6; D013925:Thromboplastin