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Published on: January 28, 2020
Association between inflammatory cytokines and long-term adverse outcomes in acute coronary syndromes: A systematic
Gisela A Kristono1,2, Ana S Holley1,2, Prashant Lakshman1
1Department of Surgery and Anaesthesia, University of Otago Wellington, New Zealand.
Insights
Predicting major adverse cardiovascular events (MACE) in acute coronary syndromes (ACS) is improved by analyzing multiple inflammatory cytokines together, rather than individually. Future research should focus on optimal multi-marker strategies.
Area of Science:
- Cardiovascular Medicine
- Immunology
- Biomarker Discovery
Background:
- Inflammatory cytokines play a role in acute coronary syndromes (ACS) pathophysiology.
- Cytokine levels are linked to major adverse cardiovascular events (MACE) in ACS patients.
Purpose of the Study:
- To systematically review studies on the predictive ability of multiple cytokines for MACE in ACS patients.
- To assess if combined cytokine analysis offers better MACE prediction than individual cytokines.
Main Methods:
- Systematic literature search of Ovid Medline, EMBASE, and Cochrane Library (1945-2017).
- Inclusion of observational studies and randomized controlled trials with ≥1 year follow-up.
- Exclusion of studies with single cytokine analysis, <1 year follow-up, non-human subjects, or late blood sampling (>10 days post-symptom onset).
Main Results:
- Ten observational studies met inclusion criteria; six had acceptable quality.
- Heterogeneity in study methods precluded meta-analysis.
- Six studies found significant associations between individual cytokines and MACE.
- Four studies analyzing combined cytokine effects reported statistically significant MACE prediction.
Conclusions:
- A combination of multiple cytokines demonstrates a stronger association with MACE than individual cytokines in ACS.
- Further research is warranted to establish optimal multi-marker methodologies for predicting MACE.
Background:
Inflammatory cytokines are involved in the pathophysiology of acute coronary syndromes (ACS) and have been associated with major adverse cardiovascular events (MACE). We systematically reviewed studies investigating the ability of multiple cytokines to predict MACE in ACS patients with follow-up of at least one year.
Methods:
A Medical Subject Heading search criteria was applied on Ovid Medline(R), EMBASE, EMBASE Classic and Cochrane Library to systematically identify relevant studies published between 1945 and 2017 that had an observational study design or were randomised controlled trials. Studies were excluded if only one cytokine was analysed, follow-up period was less than one year, subjects were non-human, or blood samples were taken more than 10 days from symptom onset.
Results:
Ten observational studies met the inclusion criteria. Six had acceptable internal validity when evaluated for quality. The studies were varied in terms of study methods (time of blood collection, study population, cytokines assessed, MACE definition, follow-up length) and result reporting, so a meta-analysis could not be conducted. Six of the studies found significant associations between individual cytokines and MACE. Four studies measured the combined effects of multiple cytokines to predict MACE, and all had statistically significant results.
Conclusion:
A combination of multiple cytokines had a better association with MACE than individual cytokines. It appears promising for future studies to determine the optimal multi-marker methodology and confirm its predictive value.
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