Impact of inflammation on adverse cardiovascular events in patients with acute coronary syndromes.

Aims: Inflammation is a key factor in the long-term outcome of acute coronary syndromes (ACS). The aim of the present study was to evaluate inflammatory markers in patients with ACS as predictors for major adverse cardiovascular events (MACE) and hard events.

Methods: This study included 1548 patients with ACS. C-reactive protein (CRP), white blood count (WBC), and their subtypes were analyzed during hospitalization. Receiver operator characteristic (ROC) and Kaplan-Meier survival curves were used to assess the predictive value and hard events (nonfatal myocardial infarction and cardiac death) and MACE (hard events, hospitalization for cardiac causes, late revascularization and stroke) were obtained during 30 days.

Results: ROC analysis of CRP and WBC to predict adverse events revealed cut-offs of 47.5 ng/l and 16.6 × 10/μl for MACE and 93.5 ng/l and 16.6 × 10/μl for hard events. The cumulative adverse event rates were significantly higher in patients with increased CRP (≥47.5 ng/l; 17 versus 4%, P < 0.001) and WBC (≥16.6 × 10/μl; 21 versus 5%, P < 0.001) for MACE and with elevated CRP (≥93.5 ng/l; 16 versus 2%, P < 0.001) and WBC (≥16.6 × 10/μl; 18 versus 2%, P < 0.001) for hard events, demonstrating highest event rates with elevation of both inflammatory markers: (28 versus 5%, P < 0.001) for MACE and (26 versus 2%, P < 0.001) for hard events. Analysis of CRP and WBC further revealed a substantial negative correlation with left ventricular function (P < 0.001). Moreover, markers of myocardial damage were significantly elevated in patients with abnormal CRP or WBC (P < 0.001).

Conclusion: Inflammatory markers such as CRP and WBC alone and, particularly, in combination are strong and independent predictors of outcome in patients with ACS.