Increasing levels of interleukin (IL)-1Ra and IL-6 during the first 2 daysof hospitalization in unstable angina are associated with increased risk of in-hospital coronary events

Background-A growing body of evidence suggests a role for inflammation in a cute coronary syndromes. The aim of this study was to assess the role of pr oinflammatory cytokines, their time course, and their association with prog nosis in unstable angina. Methods and Results-We studied 43 patients aged 62+/-8 years admitted to ou r coronary care unit for Braunwald class IIIB unstable angina. In each pati ent, serum levels of interleukin-l receptor antagonist (IL-1Ra), interleuki n-6 (IL-6) (which represent sensitive markers of biologically active IL-1 b eta and tumor necrosis factor-alpha levels, respectively), and troponin T w ere measured at entry and 48 hours after admission. Troponin T-positive pat ients were excluded. Patients were divided a posteriori into 2 groups accor ding to their in-hospital outcome: group 1 comprised 17 patients with an un eventful course, and group 2 comprised 26 patients with a complicated in-ho spital course. In group 1, mean IL-1Ra decreased at 48 hours by 12%, and IL -6 diminished at 48 hours by 13%; In group 2, IL-1Ra and IL-6 entry levels were higher than in group 1 and increased respectively by 37% and 57% at 48 hours (P<0.01), Conclusions-These findings indicate that although they receive the same med ical therapy as patients who do not experience an in-hospital event, patien ts with unstable angina and with complicated in-hospital courses have highe r cytokine levels on admission. A fall in IL-1Ra and IL-6 48 hours after ad mission was associated with an uneventful course and their increase with a complicated hospital course. These findings may suggest novel therapeutic a pproaches to patients with unstable angina.