title: Inflammatory cytokines at admission--independent prognostic markers in patients with acute coronary syndrome and hyperglycaemia.
abstract: BACKGROUND
  The clinical significance of inflammatory cytokines as independent prognostic markers in patients with acute coronary syndrome (ACS) and hyperglycaemia remains uncertain.
  
  
  OBJECTIVE
  To determine the value of inflammatory biomarkers as independent prognostic indicators and their relation with hyperglycaemia in ACS patients.
  
  
  METHODS
  TNF-α and hsCRP were defined 48 h after admission and indicators for hyperglycaemia were calculated in 256 consecutive patients with ACS. A correlation analysis with standard clinical variables--EF, maximum CK, CK-MB, troponin and different indices for hyperglycaemia was performed. Patients were followed up for 12 months.
  
  
  RESULTS
  Baseline TNF-α correlated neither to EF, nor to the enzymes for myocardial necrosis (P>0.05). In contrast, hsCRP correlated negatively with EF (P=0.001) and positively with maximum CK, CK-MB, troponin (P=0.0001) irrespectively of the glucose status. TNF-α was associated with fasting glycaemia, HGI and TAG (P=0.033/0.041/0.018) and hsCRP-with indicators for acute, persistent and chronic glycaemia in all patients. Moreover, hsCRP was an independent marker for six-month survival (P=0.024). TAG was a stronger six-month survival predictor than hsCRP (P=0.010/0.024).
  
  
  CONCLUSIONS
  hsCRP and TNF-α have clinical significance regardless of the glucose metabolic status. hsCRP is an independent marker for six-month survival. TAG is the better predictor for poor outcome than hsCRP.
authors.affiliation: University Hospital Aleksandrovska, Clinic of Cardiology, Sofia, Bulgaria. jenicherneva@yahoo.com
authors.forename: Zheyna Vlaeva
authors.initials: ZV
authors.lastname: Cherneva
authors.forename: Stefan Veselinov
authors.initials: SV
authors.lastname: Denchev
authors.forename: Mariana Vasileva
authors.initials: MV
authors.lastname: Gospodinova
authors.forename: Adelina
authors.initials: A
authors.lastname: Cakova
authors.forename: Radostina Vlaeva
authors.initials: RV
authors.lastname: Cherneva
mesh_terms: D054058:Acute Coronary Syndrome / Q000503:physiopathology*; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D001786:Blood Glucose / Q000378:metabolism; D002031:Bulgaria; D002097:C-Reactive Protein / Q000032:analysis*; D052279:Creatine Kinase, MB Form / Q000032:analysis; D016207:Cytokines / Q000032:analysis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006943:Hyperglycemia / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology*; D009206:Myocardium / Q000737:chemistry*; D011379:Prognosis; D020107:Troponin T / Q000032:analysis; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D016207:Cytokines; D020107:Troponin T; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; D052279:Creatine Kinase, MB Form