C-reactive protein, fibrinogen, interleukin-6 and tumour necrosis factor-alpha in the prognostic classification of unstable angina pectoris

BACKGROUND. inflammatory process has been found to play an important role i n the pathogenesis of coronary heart disease (CHD) and in the prognosis of CHD patients, AIM. The aim of this study was to investigate the prognostic Value of C-reactive protein (CRP), fibrinogen, interleukin (IL)-6 and tumou r necrosis factor-alpha (TNF-alpha) in patients with unstable angina pector is (UAP), including factor analysis to assess their joint effects. METHODS. The study comprised 263 consecutive patients (159 men. 104 women; median age 68 years) with UAP. Blood samples for the acute-phase protein an d cytokine determinations were drawn on admission. RESULTS. Coronary mortality during the median follow-up time of 17 months w as 6-fold higher in the highest tertile for CRP and IL-6 and 3.5-fold highe r in the highest tertile for fibrinogen and TNF-alpha than in the respectiv e combined lower tertiles. Factor analysis produced two underlying factors, ie the 'inflammation' factor, including CRP, fibrinogen and IL-6, and the 'injury' factor, including troponin T, creatine kinase MB mass and TNF-alph a. In Cox models, both of these factors were independent predictors of the risk of coronary death and major coronary events (coronary death or nonfata l myocardial infarction). CONCLUSIONS. Elevated levels of acute-phase proteins and cytokines, particu larly CRP and IL-6, are strong predictors of the risk of serious coronary e vents in patients with UAP.