title: Impact of inflammation on adverse cardiovascular events in patients with acute coronary syndromes.
abstract: OBJECTIVE
  Inflammation is a key factor in the long-term outcome of acute coronary syndromes (ACS). The aim of the present study was to evaluate inflammatory markers in patients with ACS as predictors for major adverse cardiovascular events (MACE) and hard events.
  
  
  METHODS
  This study included 1548 patients with ACS. C-reactive protein (CRP), white blood count (WBC), and their subtypes were analyzed during hospitalization. Receiver operator characteristic (ROC) and Kaplan-Meier survival curves were used to assess the predictive value and hard events (nonfatal myocardial infarction and cardiac death) and MACE (hard events, hospitalization for cardiac causes, late revascularization and stroke) were obtained during 30 days.
  
  
  RESULTS
  ROC analysis of CRP and WBC to predict adverse events revealed cut-offs of 47.5 ng/l and 16.6 × 10/μl for MACE and 93.5 ng/l and 16.6 × 10/μl for hard events. The cumulative adverse event rates were significantly higher in patients with increased CRP (≥47.5 ng/l; 17 versus 4%, P < 0.001) and WBC (≥16.6 × 10/μl; 21 versus 5%, P < 0.001) for MACE and with elevated CRP (≥93.5 ng/l; 16 versus 2%, P < 0.001) and WBC (≥16.6 × 10/μl; 18 versus 2%, P < 0.001) for hard events, demonstrating highest event rates with elevation of both inflammatory markers: (28 versus 5%, P < 0.001) for MACE and (26 versus 2%, P < 0.001) for hard events. Analysis of CRP and WBC further revealed a substantial negative correlation with left ventricular function (P < 0.001). Moreover, markers of myocardial damage were significantly elevated in patients with abnormal CRP or WBC (P < 0.001).
  
  
  CONCLUSIONS
  Inflammatory markers such as CRP and WBC alone and, particularly, in combination are strong and independent predictors of outcome in patients with ACS.
authors.affiliation: aDepartment of Cardiology, Cardiovascular Center bDepartment of Radiology, Cardiac Imaging, University Hospital Zurich cZurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland *Authors Michael Fiechter and Jelena R. Ghadri contributed equally to the writing of this work.
authors.forename: Michael
authors.initials: M
authors.lastname: Fiechter
authors.forename: Jelena R
authors.initials: JR
authors.lastname: Ghadri
authors.forename: Milosz
authors.initials: M
authors.lastname: Jaguszewski
authors.forename: Asim
authors.initials: A
authors.lastname: Siddique
authors.forename: Severin
authors.initials: S
authors.lastname: Vogt
authors.forename: Raphael B
authors.initials: RB
authors.lastname: Haller
authors.forename: Robin
authors.initials: R
authors.lastname: Halioua
authors.forename: Armin
authors.initials: A
authors.lastname: Handzic
authors.forename: Philipp A
authors.initials: PA
authors.lastname: Kaufmann
authors.forename: Roberto
authors.initials: R
authors.lastname: Corti
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lüscher
authors.forename: Christian
authors.initials: C
authors.lastname: Templin
mesh_terms: D054058:Acute Coronary Syndrome / Q000503:physiopathology*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D017023:Coronary Angiography; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D007249:Inflammation / Q000503:physiopathology*; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015996:Survival Rate; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein; D003402:Creatine Kinase