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Relation between proinflammatory to anti-inflammatory cytokine ratios and long-term prognosis in patients with non-ST elevation acute coronary syndrome
  1. T Kilic1,
  2. D Ural1,
  3. E Ural1,
  4. Z Yumuk2,
  5. A Agacdiken1,
  6. T Sahin1,
  7. G Kahraman1,
  8. G Kozdag1,
  9. A Vural1,
  10. B Komsuoglu1
  1. 1Department of Cardiology, University of Kocaeli, Kocaeli, Turkey
  2. 2Department of Microbiology, University of Kocaeli, Kocaeli, Turkey
  1. 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

Abstract

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) -1β, IL-6, tumour necrosis factor α) 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-1β and IL-6 and ratios of IL-1β: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.

  • 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
  • TNFα, tumour necrosis factor α

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Footnotes

  • Published Online First 17 March 2006

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