INFLAMMATORY MARKERS AS PREDICTORS IN UNSTABLE ANGINA

Plasma fibrinogen and C-reactive protein levels have been identified a s predictors for cardiac events in patients with stable angina pectori s (ECAT-angina pectoris study), Furthermore, elevated C-reactive prote in levels have been associated with a poor outcome in patients with se vere unstable angina, These observations indicate the presence of an i mportant inflammatory component in the pathogenesis of the acute stage s of coronary artery disease (CAD). Two hundred and eleven consecutive patients that were submitted to our department with unstable angina p ectoris were included in the APRAIS study (Acute Phase Reactions And I schaemic Syndromes). All patients had their last attack within the las t 24 hours, and ischaemic ST segment abnormalities on admission or kno wn CAD. The aim of this study is to determine the association between inflammatory processes and the long- and short-term prognosis of the d isease. Therefore, markers of chronic inflammation (CRP, interleukin-6 , fibrinogen, white blood cell count, ESR), vascular wall function (Vo n Willebrand Factor, tissue plasminogen activator, plasminogen activat or inhibitor, cellular fibronectin) and activation of the coagulation cascade (prothrombin fragment 1+2, thrombin-antithrombin complex) are measured upon admission. CRP levels were above 3 mg/L in 100 patients (47%), and fibrinogen was higher than 3.5 mg/L in 94 patients (45%). T his indicates a role of inflammatory processes in the pathogenesis of the disease. The plasma fibrinogen levels on admission were associated with an increased risk of myocardial infarction or cardiac death (P = 0.005, using logistic regression with age, gender and smoking habits as covariables).