CARDIOVASCULAR MEDICINE

Relation between proinflammatory to anti-inflammatory cytokine ratios and long-term prognosis in patients with non-ST elevation acute coronary syndrome

T Kilic¹, D Ural¹, E Ural¹, Z Yumuk², A Agacdiken¹, T Sahin¹, G Kahraman¹, G Kozdag¹, A Vural¹, B Komsuoglu¹

¹ Department of Cardiology, University of Kocaeli, Kocaeli, Turkey
² Department of Microbiology, University of Kocaeli, Kocaeli, Turkey

Correspondence to:
Dr Teoman Kilic
Cardiology Department, Kocaeli University Medical Faculty, Cumhuriyet Mah Coruh Sok Dogus Apt A Blok Kat:1 Daire: 4 Izmit/Kocaeli, Kocaeli, 41100 Turkey; kilicteoman{at}yahoo.com

Objective: To investigate the relation between serum high sensitivity (hs) C reactive protein (CRP), proinflammatory cytokine concentrations, proinflammatory to anti-inflammatory cytokine ratios and long-term prognosis in patients with non-ST elevation acute coronary syndrome (NSTEACS).

Design: Prospective follow-up study for the first six months and then for the first year after admission to hospital.

Setting: Tertiary referral centre.

Patients: 80 patients (60 men, 20 women, mean age 60 (SD 10) years) with NSTEACS and moderate to high TIMI (Thrombolysis In Myocardial Infarction) risk scores.

Interventions: Blood samples from patients with NSTEACS were obtained at the time of admission. Serum concentrations of hs-CRP, (hs) pro-inflammatory (interleukin (IL) -1ß, IL-6, tumour necrosis factor ) and (hs) anti-inflammatory (IL-10) cytokines were analysed and proinflammatory to anti-inflammatory cytokine ratios were calculated by dividing proinflammatory cytokine concentrations by anti-inflammatory cytokine IL-10.

Main outcome measure: The primary end point of the study was new coronary events (NCE) defined as the combination of cardiac death, non-fatal myocardial infarction and recurrent rest angina that required hospitalisation within 12 months of follow up.

Results: During the one-year follow-up period, 23 patients (29%) met the NCE criteria. Concentrations of hs-CRP, IL-1ß and IL-6 and ratios of IL-1ß:IL-10 and IL-6:IL-10 were significantly higher in patients with NCE than in patients without NCE. In the logistic regression analysis, IL-6:IL-10 ratio was the most important predictor for NCE (p = 0.006) with an odds ratio of 2.24 (95% CI 1.26 to 3.97).

Conclusions: Cytokine concentrations and proinflammatory to anti-inflammatory cytokine ratios may be useful markers for predicting vascular risk in patients with NSTEACS.

Abbreviations: CRP, C-reactive protein; hs, high sensitivity; IL, interleukin; MI, myocardial infarction; NCE, new coronary events; NSTEACS, non-ST elevation acute coronary syndrome; ROC, receiver operating characteristic; TIMI, Thrombolysis In Myocardial Infarction; TNF, tumour necrosis factor

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