Inflammatory status as a main determinant of outcome in patients with unstable angina, independent of coagulation activation and endothelial cell function

Aims Inflammation, endothelial cell function and the coagulation system hav e been demonstrated to be involved in the onset and course of unstable angi na. Whether a proinflammatory state independently determines outcome is unk nown and has not been determined yet in a clinically well defined study pop ulation of consecutive patients admitted with unstable angina. Methods and Results Markers of inflammation, coagulation activation and end othelial cell function were determined on admission in blood of 211 consecu tive patients with severe unstable angina and were related to the in-hospit al course. Refractory unstable angina occurred in 76 patients (36%) during their hospital stay. In a univariate analysis, C-reactive protein (P=0.03), fibrinogen (P<0.001) and erythrocyte sedimentation rate (P=0.001) levels w ere significantly higher in patients with refractory unstable angina, when compared with patients who had an uneventful clinical course. The odds rati os (95% CI) adjusted for age, sex, body mass index, smoking behaviour and c holesterol levels of the occurrence of refractory unstable angina for patie nts in the highest quartile compared with patients in the lowest quartile o f inflammatory markers were 2.19 (0.94-5.11) for C-reactive protein, 2.83 ( 1.13-7.10) for fibrinogen and 4.72 (1.70-13.09) for the erythrocyte sedimen tation rate. The findings were not affected by the presence or absence of m yocardial necrosis or the interval between onset of angina and blood collec tion. No association was found between markers of coagulation activation or markers of endothelial cell function, and in-hospital outcome. Conclusion We found that in a clinically well-defined study population of p atients with severe unstable angina, a proinflammatory state is an importan t and independent determinant of short-term outcome. The data strengthen th e importance of inflammation in this syndrome.