C-reactive protein, interleukin-6, secretory phospholipase A2 group IIA and intercellular adhesion molecule-1 in the prediction of late outcome events after acute coronary syndromes
Article first published online: 1 OCT 2007
Journal of Internal Medicine
Volume 262, Issue 5, pages 526–536, November 2007
How to Cite
Hartford, M., Wiklund, O., Mattsson Hultén, L., Persson, A., Karlsson, T., Herlitz, J. and Caidahl, K. (2007), C-reactive protein, interleukin-6, secretory phospholipase A2 group IIA and intercellular adhesion molecule-1 in the prediction of late outcome events after acute coronary syndromes. Journal of Internal Medicine, 262: 526–536. doi: 10.1111/j.1365-2796.2007.01862.x
- Issue published online: 1 OCT 2007
- Article first published online: 1 OCT 2007
- acute coronary syndromes;
- inflammatory markers;
Objective. We investigated whether levels of C-reactive protein (CRP), interleukin-6 (IL-6), secretory phospholipase A2 group IIA (sPLA2-IIA) and intercellular adhesion molecule-1 (ICAM-I) predict late outcomes in patients with acute coronary syndromes (ACS).
Design. Prospective longitudinal study. CRP (mg L−1), IL-6 (pg mL−1), sPLA2-IIA (ng mL−1) and ICAM-1 (ng mL−1) were measured at days 1 (n = 757) and 4 (n = 533) after hospital admission for ACS. Their relations to mortality and rehospitalization for myocardial infarction (MI) and congestive heart failure (CHF) were determined.
Setting. Coronary Care Unit at Sahlgrenska University Hospital, Gothenburg, Sweden.
Subjects. Patients with ACS alive at day 30; median follow-up 75 months.
Results. Survival was related to day 1 levels of all markers. After adjustment for confounders, CRP, IL-6 and ICAM-1, but not sPLA2-IIA, independently predicted mortality and rehospitalization for CHF. For CRP, the hazard ratio (HR) was 1.3 for mortality (95% confidence interval (CI): 1.1–1.5, P = 0.003) and 1.4 for CHF (95% CI: 1.1–1.9, P = 0.006). For IL-6, HR was 1.3 for mortality (95% CI: 1.1–1.6, P < 0.001) and 1.4 for CHF (95% CI: 1.1–1.8, P = 0.02). For ICAM-1, HR was 1.2 for mortality (95% CI: 1.0–1.4, P = 0.04) and 1.3 for CHF (95% CI: 1.0–1.7, P = 0.03). No marker predicted MI. Marker levels on day 4 provided no additional predictive value.
Conclusions. In patients with ACS, CRP, IL-6, sPLA2-IIA and ICAM-1 are associated with long-term mortality and CHF, but not reinfarction. CRP, IL-6 and ICAM-1 provide prognostic information beyond that obtained by clinical variables.