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Interleukin-6 and high-sensitivity C-reactive protein for the prediction of outcomes in non-ST-segment elevation
Ángel López-Cuenca1, Sergio Manzano-Fernández2, Gregory Y H Lip3
1Departamento de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
Insights
Serial interleukin-6 (IL-6) measurements improve risk prediction in non-ST-segment elevation acute coronary syndrome (NSTE-ACS). IL-6 levels at 30 days significantly enhance prognostic stratification beyond baseline markers.
Area of Science:
- Cardiology
- Biomarkers
- Acute Coronary Syndromes
Background:
- Elevated baseline interleukin-6 (IL-6) and C-reactive protein (CRP) indicate higher mortality risk in non-ST-segment elevation acute coronary syndrome (NSTE-ACS).
- Current risk stratification may not fully capture prognostic nuances in NSTE-ACS patients.
Purpose of the Study:
- To evaluate if serial IL-6 and high-sensitivity C-reactive protein (hs-CRP) measurements offer improved risk stratification in NSTE-ACS.
- To assess the added value of dynamic biomarker changes over baseline levels.
Main Methods:
- Prospective study of 216 NSTE-ACS patients.
- Blood samples collected at hospital admission (day 1) and 30-day follow-up.
- Endpoint: composite of all-cause death, nonfatal myocardial infarction, or acute decompensated heart failure.
Main Results:
- Both IL-6 and hs-CRP levels decreased significantly from day 1 to day 30.
- IL-6 levels at both day 1 and day 30 were independent predictors of adverse events.
- Serial IL-6 measurements significantly improved risk model discrimination (C-index increase from 0.71 to 0.80, P=.042) and reclassification (NRI=0.39, P=.002).
Conclusions:
- IL-6 and hs-CRP concentrations decline post-acute phase in NSTE-ACS patients.
- Serial IL-6 measurements provide significant added value for prognostic risk stratification in NSTE-ACS.
Introduction And Objectives:
High baseline levels of interleukin-6 and C-reactive protein confer an increased risk of mortality in non-ST-segment elevation acute coronary syndrome. The aim of the study was to determine whether serial measurements of interleukin-6 and high-sensitivity C-reactive protein provide additional information to baseline measurements for risk stratification of non-ST-segment elevation acute coronary syndrome.
Methods:
Two hundred and sixteen consecutive patients with non-ST-segment elevation acute coronary syndrome were prospectively included. Blood samples were obtained within 24 h of hospital admission and at 30 days of follow-up. The endpoint was a composite of all-cause death, nonfatal myocardial infarction, or acute decompensated heart failure.
Results:
Both interleukin-6 and high-sensitivity C-reactive protein levels decreased from day 1 to day 30, regardless of adverse events (both P<.001). Interleukin-6 levels at 2 time points (interleukin-6 day 1, per pg/mL; hazard ratio=1.006, 95% confidence interval, 1.002-1.010; P=.002 and interleukin-6 day 30, per pg/mL, hazard ratio=1.047, 95% confidence interval, 1.021-1.075, P<.001) were independent predictors of adverse events, whereas high-sensitivity C-reactive protein day 1 and high-sensitivity C-reactive protein day 30 levels were not. Patients with interleukin-6 day 1≤8.24 pg/mL and interleukin-6 day 30≤4.45 pg/mL had the lowest event rates (4.7%), whereas those with both above the median values had the highest event rates (35%). After addition of interleukin-6 day 30 to the multivariate model, C-index increased from 0.71 (95% confidence interval, 0.63-0.78) to 0.80 (95% confidence interval, 0.72-0.86), P=.042, and net reclassification improvement was 0.39 (95% confidence interval, 0.14-0.64; P=.002).
Conclusions:
In this population, both interleukin-6 and high-sensitivity C-reactive protein concentrations decreased after the acute phase. Serial samples of interleukin-6 concentrations improved the prognostic risk stratification of these patients.
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