title: Influence of pre-existing inflammation on the outcome of acute coronary syndrome: a cross-sectional study.
abstract: OBJECTIVE
  Inflammation is a well-established risk factor for the development of coronary artery disease (CAD) and acute coronary syndrome (ACS). However, less is known about its influence on the outcome of ACS. The aim of this study was to determine if blood biomarkers of inflammation were associated specifically with acute myocardial infarction (MI) or unstable angina (UA) in patients with ACS.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Patients admitted to the coronary care unit, via the emergency room, at a central county hospital over a 4-year period (1992-1996).
  
  
  METHODS
  In a substudy of Carlscrona Heart Attack Prognosis Study (CHAPS) of 5292 patients admitted to the coronary care unit, we identified 908 patients aged 30-74 years, who at discharge had received the diagnosis of either MI (527) or UA (381).
  
  
  METHODS
  MI or UA, based on the diagnosis set at discharge from hospital.
  
  
  RESULTS
  When adjusted for smoking, age, sex and duration of chest pain, concentrations of plasma biomarkers of inflammation (high-sensitivity C reactive protein>2 mg/L (OR=1.40 (1.00 to 1.96) and fibrinogen (p for trend=0.035)) analysed at admission were found to be associated with MI over UA, in an event of ACS. A strong significant association with MI over UA was found for blood cell markers of inflammation, that is, counts of neutrophils (p for trend<0.001), monocytes (p for trend<0.001) and thrombocytes (p for trend=0.021), while lymphocyte count showed no association. Interestingly, eosinophil count (p for trend=0.003) was found to be significantly lower in patients with MI compared to those with UA.
  
  
  CONCLUSIONS
  Our results show that, in patients with ACS, the blood cell profile and degree of inflammation at admission was associated with the outcome. Furthermore, our data suggest that a pre-existing low-grade inflammation may dispose towards MI over UA.
authors.affiliation: Department of Proteomics, KTH, Science for Life Laboratory Stockholm, Solna, Sweden Centre for Hematology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Jacob
authors.initials: J
authors.lastname: Odeberg
authors.affiliation: Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden.
authors.forename: Michael
authors.initials: M
authors.lastname: Freitag
authors.affiliation: Blekinge Centre of Competence, Karlskrona, Sweden.
authors.forename: Henrik
authors.initials: H
authors.lastname: Forssell
authors.affiliation: Department of Laboratory Medicine, Blekinge County Hospital, Karlskrona, Sweden.
authors.forename: Ivar
authors.initials: I
authors.lastname: Vaara
authors.affiliation: Department of Laboratory Medicine, Blekinge County Hospital, Karlskrona, Sweden.
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Persson
authors.affiliation: Blekinge Centre of Competence, Karlskrona, Sweden.
authors.forename: Håkan
authors.initials: H
authors.lastname: Odeberg
authors.affiliation: Research Unit of General Practice, University of Southern Denmark, Odense, Denmark.
authors.forename: Anders
authors.initials: A
authors.lastname: Halling
authors.affiliation: Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden.
authors.forename: Lennart
authors.initials: L
authors.lastname: Råstam
authors.affiliation: Department of Community Medicine/Primary Health Care, University of Gothenburg, Göteborg, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Lindblad
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000473:pathology*; D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000097:blood / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D007249:Inflammation / Q000097:blood; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis*; D010976:Platelet Count; D012307:Risk Factors; D000685:Serum Amyloid A Protein / Q000378:metabolism
chemical_list: D015415:Biomarkers; D000685:Serum Amyloid A Protein; D005340:Fibrinogen; D002097:C-Reactive Protein
keywords: Inflammation; acute coronary syndrome