scholarly journals P0585ANEMIA AS A PROGNOSTIC FACTOR IN CONTRAST-INDUCED ACUTE KIDNEY INJURY IN PATIENTS WITH STABLE CORONARY ARTERY DISEASE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Olga Mironova ◽  
Olga Perekosova ◽  
Alina Ushanova ◽  
Georgy Isaev ◽  
Alexander Ermolaev ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Primary Outcome ◽  
Stable Coronary Artery Disease ◽  
Kidney Injury ◽  
Number Of Patients ◽  
Artery Disease ◽  
Stable Cad ◽  
Heart Failure Decompensation

Abstract Background and Aims Contrast-induced acute kidney injury (CI-AKI) remains one of the major obstacles to perform percutaneous coronary interventions (PCI), especially in older patients and in patients with comorbidities. The number of cases of stable coronary artery disease (CAD) requiring such kind of interventions, in spite of optimal medical treatment received, remains high. Diabetes, hyperuricemia and other components of metabolic syndrome, as well as heart failure, are well known risk factors predisposing to the development of CI-AKI after contrast exposure. Anaemia is diagnosed in a number of patients without underlying chronic kidney disease (CKD), when they seek for medical help due to CAD. The aim of our study was to assess the prevalence of CI-AKI (primary outcome) and the prognostic significance of anaemia as a its possible risk factor (secondary outcome) in different groups of patients with stable CAD requiring PCI using the contrast media. Method We conducted a single-centre prospective observational cohort study. 561 patients aged 18-89 with stable CAD undergoing PCI were enrolled from June 2012 until October 2013. The CI-AKI was defined as a rise in serum creatinine of ≥0,5 mg/dl (≥44μmol/l) or a 25% increase from baseline value, assessed at 48-72 hours after PCI. Anaemia was defined according to the WHO definition – haemoglobin level <12,0 g/dl in women and <13,0 g/dl in men. The contrast media used was either iodixanol (iso-osmolar contrast) or iopromide (low-osmolar contrast), which are both known to cause less adverse events than high-osmolar types of contrast. Nephrotoxic drugs were stopped 48 hours before PCI. The 5-year prognosis including all-cause and cardiovascular mortality, myocardial infarction, stroke, gastrointestinal bleeding, decompensation of chronic heart failure, repeat revascularizations (PCI and coronary artery bypass grafting), end-stage renal disease (ESRD) development, was assessed via phone calls and appointments according to the clinical situation and severity of the condition. Results The prevalence of CI-AKI in this group of patients was 104 cases (18,5%) (primary outcome). The number of patients with anaemia was higher in the group of patients who developed CI-AKI after PCI (6% [7/104] vs 4,4% [20/457]). The female patients with anaemia were more likely to develop CI-AKI (71% [5/7] vs 35% [7/20]). The number of patients who suffered from MI having anaemia at the inclusion date was 2 (28,6%) vs 6 (30%) in patients with and without CI-AKI respectively. Acute heart failure decompensation in patients with anaemia was significantly higher in patients with CI-AKI (43% [3/7] vs 10% [2/20]). This fact needs further evaluation in larger studies but anaemia may be one of the prognostic factors, worsening the kidney damage and leading to worse cardiorenal outcomes. Conclusion Patients with stable CAD suffering from anaemia are more likely to develop CI-AKI even without underlying CKD or ESRD. Female patients with anaemia and stable CAD have higher risk of development of CI-AKI. The combination of CI-AKI and anaemia may lead to a higher 5-year risk of acute heart failure decompensation.

Abstract 23: N -Terminal Fragment of the Prohormone Brain-Type Natriuretic Peptide (NT-proBNP) vs. BNP for Predicting Heart Failure in Patients with Stable Coronary Artery Disease: the Heart and Soul Study.

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Rakesh K Mishra ◽  
Mathilda Regan ◽  
Alan H Wu ◽  
Mary A Whooley
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Natriuretic Peptide ◽  
Primary Outcome ◽  
Left Ventricular ◽  
Amino Terminal ◽  
Prognostic Utility ◽  
Artery Disease ◽  
Stable Cad

Background The B-type natriuretic peptide (brain natriuretic peptide [BNP] and its amino terminal pro-BNP [NT-proBNP]) are powerful predictors of adverse cardiovascular outcomes, including heart failure (HF), in patients with coronary artery disease (CAD). However, their relative prognostic utility remains uncertain. We compared the ability of NT-proBNP and BNP to predict HF hospitalizations in patients with stable CAD. Methods We studied the relative prognostic utility of NT-proBNP and BNP in 983 participants with stable CAD from the Heart and Soul Study. The primary outcome was time to HF hospitalization. Results During an average of 6.7 ± 3.0 years follow-up, there were 173 hospitalizations for HF. NT-proBNP and BNP levels were strongly correlated with one another (r=0.87; p<0.001). In demographically-adjusted models, HF hospitalization was predicted similarly by NT-proBNP (HR per 1-SD increase in log-transformed level: 3.1; 95% C.I. 2.7 - 3.7; p<0.001) and BNP (HR per 1-SD increase in log-transformed level: 3.0; 95% C.I. 2.5 - 3.6; p<0.001). This finding persisted after adjustment for traditional coronary risk factors, history of HF, left ventricular (LV) systolic and diastolic function and LV mass index, with NT-proBNP (HR per 1-SD increase in log-transformed level: 3.4; 95% C.I. 2.5 - 4.5; p<0.001) and BNP (HR per 1-SD increase in log-transformed level: 3.0; 95% C.I. 2.3 - 3.8; p<0.001) continuing to predict the primary outcome similarly. Moreover, in fully adjusted ROC analyses, NT-proBNP (AUC 0.87) and BNP (AUC 0.86; p=0.19 for comparison) performed similarly for predicting HF hospitalization. Conclusions NT-proBNP and BNP are secreted in equimolar amounts and perform similarly for predicting HF hospitalization in patients with stable CAD. This suggests that their relative prognostic utility is not affected by differences in their biological half-lives, in vitro stability and mechanisms of clearance.

scholarly journals Comparison of 3 Predictive Clinical Risk Scores in 603 Patients with Stable Coronary Artery Disease

2017 ◽  
Vol 44 (4) ◽  
pp. 239-244
Author(s):  
Álvaro Aceña ◽  
Maria Luisa Martín-Mariscal ◽  
Nieves Tarín ◽  
Carmen Cristóbal ◽  
Ana Huelmos ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Primary Outcome ◽  
Stable Coronary Artery Disease ◽  
Thrombotic Event ◽  
Risk Scores ◽  
Clinical Risk ◽  
Secondary Outcomes ◽  
Artery Disease

No clinical risk score is universally accepted for coronary artery disease. In 603 patients (mean age, 61.2 ± 12.3 yr) with stable coronary artery disease, we investigated the predictive power of clinical risk scores derived from the Framingham, the Long-term Intervention with Pravastatin in Ischemic Disease (LIPID), and the Vienna and Ludwigshafen Coronary Artery Disease (VILCAD) studies. Secondary outcomes were the recurrence of an acute thrombotic event (coronary events, strokes, or transient ischemic attacks), or heart failure or death. The primary outcome was the combination of secondary outcomes. During follow-up (duration, 2.08 ± 0.97 yr), 42 patients had an acute thrombotic event; 22, heart failure or death; and 60, the primary outcome. The Framingham score predicted acute thrombotic events: hazard ratio (HR)=1.05; 95% confidence interval (CI), 1.01–1.08; P=0.03; net reclassification index (NRI, calculated to evaluate improvement in prediction gained by adding different risk scores to models constructed with variables excluded from the calculation of that score)=9.7% (95% CI, 9.6–9.8). The LIPID (HR=1.13; 95% CI, 1.04–1.22; P=0.005) and VILCAD scores (HR=1.99; 95% CI, 1.48–2.67; P &lt;0.001) predicted heart failure or death with NRIs of 5.8% (95% CI, 5.7–5.9) and 18.6% (95% CI, 18.3–18.9), respectively. The primary outcome was predicted by the LIPID (HR=1.1; 95% CI, 1.03–1.17; P=0.005) and VILCAD scores (HR=1.39; 95% CI, 1.13–1.70; P=0.003). The NRIs (95% CIs) were 3.4% (3.3–3.5) and 19.4% (19.3–19.6), respectively. We conclude that the accuracy of these risk scores varies in accordance with the outcome studied.

scholarly journals Hyperuricemia as a risk factor of contrast-induced acute kidney injury

2021 ◽  
Vol 23 (1) ◽  
pp. 25-27
Author(s):  
Olga Iu. Mironova ◽  
◽  
Polina G. Lakotka ◽  
Viktor V. Fomin ◽  
◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Acute Kidney Injury ◽  
Uric Acid ◽  
Risk Factor ◽  
Coronary Artery ◽  
Statistical Significance ◽  
Kidney Injury ◽  
Number Of Patients ◽  
Artery Disease ◽  
Stable Cad

Aim. To assess the prevalence of contrast-induced acute kidney injury (CI-AKI) in patients with stable coronary artery disease (CAD) and hyperuricemia. Materials and methods. Patients with stable CAD receiving optimal medical therapy and with indications to coronary angiography and possible coronary angioplasty were included in an observational open prospective cohort study. The protocol of the study was registered in clinicaltrials.gov with ID NCT04014153. We conducted a sub-analysis of the group of patients with hyperuricemia (uric acid level >7 mg/dl). Results. We included 1023 patients with stable CAD. 32 patients suffered from hyperuricemia. The rate of CI-AKI in this group was 6.25% (2 patients), that was lower than in patients with normal levels of uric acid (13.1%). The difference was not statistically significant probably due to the small number of patients with hyperuricemia. The patients with hyperuricemia had proteinuria 3 times more frequently, than patients without, the rate of diabetes mellitus was 7% higher as well as anemia by 4.5% but didn’t reach statistical significance. Conclusion. The rate of CI-AKI in patients with hyperuricemia was twice lower than in patients with normal levels of uric acid. More research needs to be conducted in patients with metabolic syndrome in larger groups. Keywords: contrast-induced acute kidney injury, contrast-associated acute kidney injury, contrast-induced nephropathy, coronary artery disease, percutaneous coronary intervention, contrast, hyperuricemia For citation: Mironova OIu, Lakotka PG, Fomin VV. Hyperuricemia as a risk factor of contrast-induced acute kidney injury. Consilium Medicum. 2021; 23 (1): 25–27. DOI: 10.26442/20751753.2021.1.200572

scholarly journals Hyperuricemia in patients with stable coronary artery disease and arterial hypertension and percutaneous coronary interventions

2020 ◽  
Vol 22 (12) ◽  
pp. 20-22
Author(s):  
Olga Iu. Mironova ◽  
◽  
Viktor V. Fomin ◽  
Keyword(s):  
Coronary Artery Disease ◽  
Acute Kidney Injury ◽  
Coronary Artery ◽  
Linear Regression ◽  
Arterial Hypertension ◽  
Stable Coronary Artery Disease ◽  
Kidney Injury ◽  
Multiple Linear Regression Model ◽  
Artery Disease ◽  
Stable Cad

Aim. To assess the influence of hyperuricemia on the risk of contrast-induced acute kidney injury (CI-AKI) in patients with stable coronary artery disease (CAD) and arterial hypertension. Materials and methods. Patients receiving optimal medical therapy and with indications for coronary angiography and possible coronary angioplasty, with stable CAD and arterial hypertension were included in the study. We conducted an observational open prospective cohort study, that was registered in clinicaltrials.gov with ID NCT04014153. Results. We included 1023 patients with chronic CAD. 863 had arterial hypertension. Hyperuricemia was diagnosed in 31 patients, 832 had normal levels of uric acid on admission. Contrast-induced acute kidney injury developed in 2 (6.5%) patients suffering from hyperuricemia. In patients with stable CAD, AH and no hyperuricemia the rate of CI-AKI was 107 (12.9%) patients. The difference between groups was not statistically significant (95% CI -0.056–0.183, р=0.292). We built a multiple linear regression model that included age, weight, female gender, heart failure, diabetes mellitus, kidney diseases in past medical history, protei-nuria, anemia, baseline glomerular filtration rate, contrast volume and difference between baseline creatinine and creatinine after contrast administration. No risk factor showed any statistical significance in the model. Conclusion. Contrast-induced acute kidney injury developed in 2 (6.5%) patients suffering from hyperuricemia. The rate of CI-AKI in patients without hyperuricemia was twice higher but the results were not statistically significant. Among the risk factors included in the multiple linear regression model none was statistically significant.

scholarly journals Medicamentous therapy of stable coronary artery disease sensu the guidelines on myocardial revascularization

2020 ◽  
Author(s):  
Olga Posnenkova ◽  
Ekaterina Genkal ◽  
Yulia Popova ◽  
Anton Kiselev ◽  
Vladimir Gridnev
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Russian Federation ◽  
Stable Coronary Artery Disease ◽  
Myocardial Revascularization ◽  
The Russian Federation ◽  
Artery Disease ◽  
Stable Cad ◽  
Multicenter Registry

Objective: based on the Russian Federation multicenter registry data, to assess the comprehensiveness of medicamentous therapy in patients with stable coronary artery disease (CAD) from the perspective of 2018 European Society of Cardiology (ESC-2018) recommendations for myocardial revascularization and 2017 American Appropriate Use Criteria (AUC-2017) for the expediency of revascularization. Materials and methods. Anamnestic data of 1531 patients with stable CAD (average age: 61.7 ± 9.8 years; 76% men) were studied. The data source was the Russian Federation multicenter registry of patients with arterial hypertension, CAD, and chronic heart failure. We identified the prescription of optimal medical therapy (OMT) sensu ESC-2018, maximal anti-ischemic therapy (MAT) sensu AUC-2017, and compliance of drug therapy with ESC-2018 and AUC-2017 simultaneously. OMT included at least one anti-ischemic medication + antiplatelet agent + statin + short-acting nitrate + blocker of the renin-angiotensin system in the presence of hypertension, diabetes mellitus, or heart failure. MAT included at least two anti-ischemic pharmaceutical drugs. Compliance with these criteria was determined in the groups of patients who underwent, or did not undergo, myocardial revascularization, as well as among those, for whom invasive treatment was indicated as the first priority, as the second priority, or was not indicated at all, according to ESC-2018 and AUC-2017. Results. Among patients who received solely medicamentous therapy (n=924), OMT was prescribed in 18%, while in the revascularization group (n= 07), in 9% of cases (p <0.001). MAT was also prescribed more often in the conservative therapy group (34%) than in the revascularization group (24%): p = 0.001. OMT sensu ESC-2018 and AUC-2017 in the groups with, or without, intervention was prescribed in 3% vs. 7% of cases, respectively (p <0.001). Conclusion. According to the Russian Federation multicenter registry, medicamentous therapy of stable CAD complies with the provisions of European and American clinical guidelines for myocardial revascularization in a small proportion of patients, regardless of the chosen treatment tactics.

scholarly journals Prognostic value of serum soluble ST2 in stable coronary artery disease: a prospective observational study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hack-Lyoung Kim ◽  
Jung Pyo Lee ◽  
Nathan Wong ◽  
Woo-Hyun Lim ◽  
Jae-Bin Seo ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Stable Coronary Artery Disease ◽  
Stable Condition ◽  
Baseline Serum ◽  
Soluble St2 ◽  
Increased Risk ◽  
Artery Disease ◽  
Stable Cad

AbstractThe role of ST2 in stable coronary artery disease (CAD) has not yet been well defined. This study was performed to investigate baseline serum soluble ST2 (sST2) level can predict clinical outcomes in patients with stable CAD. A total of 388 consecutive patients with suspected CAD (65 years and 63.7% male) in stable condition referred for elective invasive coronary angiography (ICA) was prospectively recruited. Major adverse cardiovascular event (MACE), including cardiac death, non-fatal myocardial infarction, coronary revascularization (90 days after ICA), and ischemic stroke during clinical follow-up was assessed. Most of the patients (88.0%) had significant CAD (stenosis ≥ 50%). During median follow-up of 834 days, there was 29 case of MACE (7.5%). The serum sST2 level was significantly higher in patients with MACE than those without (47.3 versus 30.6 ng/ml, P < 0.001). In multiple Cox regression model, higher sST2 level (≥ 26.8 ng/ml) was an independent predictor of MACE even after controlling potential confounders (hazard ratio, 13.7; 95% confidence interval 1.80–104.60; P = 0.011). The elevated level of baseline sST2 is associated with an increased risk of adverse clinical events in stable CAD patients. Studies with larger sample size are needed to confirm our findings.

scholarly journals Acute Coronary Syndrome in Patients with Thrombotic Thrombocytopenic Purpura

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 4-5
Author(s):  
Moataz Ellithi ◽  
Fouad Khalil ◽  
Smitha N Gowda ◽  
Waqas Ullah ◽  
Radowan Elnair ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Thrombotic Microangiopathy ◽  
Kidney Injury ◽  
Coronary Syndrome ◽  
Icd 10 ◽  
History Of ◽  
Artery Disease

Introduction: Thrombotic thrombocytopenic purpura (TTP) is a life-threatening clinical syndrome characterized by microangiopathy and a variable degree of end-organ ischemic damage. Cardiac involvement has been recognized as a major cause of mortality in these patients (Patschan et al, Nephrol Dial Transplant, 2006; Benhamou et al, J Thromb. Haemost, 2015). In this study, we aim to investigate clinical predictors and outcomes of acute coronary syndrome in the setting of TTP admissions. Methods: The National Inpatient Sample (NIS) was queried for all hospitalizations with a primary diagnosis of thrombotic microangiopathy (ICD- 9-CM code 4466 and ICD-10-CM code M3.11) from 2002 to 2017. Using ICD-9-CM procedure codes (9972), (9971), and (9979), as well as ICD-10-CM procedure codes (6A551Z3) and (6A550Z3) we identified patients who received plasma exchange (PLEX) during the same admission. Due to the wide spectrum of thrombotic microangiopathy diseases, we decided to include only those who received PLEX to get a more specific subpopulation who were presumed to have TTP. We stratified patients based on whether or not they had acute coronary syndrome (ACS) during the admission, defined as presence of any ICD code for either ST-segment elevation myocardial infarction (STEMI), Non-STEMI, or unstable angina. Baseline characteristics and inpatient outcomes were compared between groups. Statistical analysis was performed using SPSS v26 (IBM Corp, Armonk, NY, USA). The odds ratio (OR) and 95% confidence interval (CI) were calculated using the Cochran-Mantel-Haenszel test. A multivariate regression model was deployed to assess predictors of inpatient mortality. Complex weights were used throughout all calculations, enabling appropriate national projections. Results: A total of 15,640 patients with the diagnosis of thrombotic microangiopathy were identified during the studied period. Of those, 6,214 patients had received PLEX treatment during their admission (39.7%). The annual admission rate for TTP was ranging between 5-7/100,000 admissions. Patients had a mean age of 47.8 years; 67% were females, and 46.5% were Caucasian. Stratifying by geographic region, 24% were from the Northeast, 21% from the Midwest, 42% from the South, and 13% from the West. The most common primary payer was private insurance (42.7%). Overall inpatient mortality was 9.1%. The most common complications reported included acute kidney injury (42.5%), followed by acute respiratory failure (14.9%), incident dialysis (14.3%), acute encephalopathy (7.7%), acute heart failure (7.3%), acute cerebrovascular accident (7.2%), and acute coronary syndrome (6.3%). ACS was documented in 6.7% of patients. Compared with patients without ACS, those with ACS were relatively older and had a relatively higher prevalence of coronary artery disease, dyslipidemia, diabetes mellitus, essential hypertension, chronic kidney disease, and heart failure. Patients with ACS had a 3-fold higher in-hospital mortality and a longer mean hospital stay (19 days vs. 15 days, P&lt;0.001). Using stepwise logistic regression, we identified age (aOR 1.03; 95% CI, 1.02 - 1.03; P &lt;0.001), history of heart failure (aOR 2.02; 95% CI, 1.53-2.67; P &lt;0.001), and history of coronary artery disease (aOR 2.69; 95% CI, 2.03 - 3.57; P &lt;0.001) as independent predictors of ACS among patients hospitalized with TTP. On another regression analysis, certain complications were more prevalent in the ACS group including acute cerebrovascular accidents, acute heart failure, acute kidney injury, cardiogenic shock, and respiratory failure. Conclusion: Despite wider utilization of therapeutic plasmapheresis and improved supportive treatments for patients with TTP, associated morbidity and mortality remain significant. We demonstrate from this large retrospective cohort that ACS is an independent predictor of higher morbidity and mortality in TTP patients. We identified older age, history of heart failure, and history of coronary artery disease as independent predictors of ACS among patients admitted with TTP. Further studies are warranted to develop risk stratification models for patients with TTP. Figure Disclosures Anwer: Incyte, Seattle Genetics, Acetylon Pharmaceuticals, AbbVie Pharma, Astellas Pharma, Celegene, Millennium Pharmaceuticals.: Honoraria, Research Funding, Speakers Bureau.

Abstract 177: Interleukin 17 and Coronary Stenosis in Patients With Stable Coronary Artery Disease

2015 ◽  
Vol 117 (suppl_1) ◽  
Author(s):  
Dinaldo Oliveira ◽  
Elaine Heide ◽  
Maira Pita ◽  
Danielle A Oliveira ◽  
Ricardo Pontes ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Stenosis ◽  
Stable Coronary Artery Disease ◽  
Myocardial Revascularization ◽  
Interleukin 17 ◽  
Left Circumflex Artery ◽  
Artery Disease ◽  
Stable Cad

Introduction: The role of the immune and inflammatory pathways in patients with coronary artery disease (CAD) is important but not complete understood. The aim of this study was to evaluate concentrations of the interleukins 17 (IL 17) according to severity of coronary stenosis in patients with stable CAD Hypothesis: There is no association between severity of coronary stenosis and IL 17 in patients with stable CAD. Methods: This is a cross-sectional, prospective, analytical study, conducted from january to september, 2013. We included 40 patients (P) with stable CAD, CCS III or IV, ischemic myocardial scintigraphy, who had not been subjected to any kind of myocardial revascularization and with coronary stenosis ≥ 50% according to current coronary angiography. There were 20 healthy volunteers (C), to take up comparison of concentrations of IL 17. Interleukins were evaluated in serum of patients and after 48 hours of cells in culture with and without stimulus. IL 17 A concentrations were expressed in pg / ml. Coronary stenosis were classified as severe (> 70%) [SS] and intermediate (50 - 69%) [MS] according to coronary angiography. Results: Stenosis ≥ 50% were found in the anterior descending artery in 31 patients, in the left circumflex artery in 19 patients, and in the right coronary artery in 24 patients. No cases of stenosis were observed in the left main. Eighteen patients (45%) had single-artery disease, 8 patients (20%) had two-artery disease, and 14 patients (35%) had multiarterial disease. The comparison between the groups showed: IL 17: Serum: P with SS = 3.91 (3.91 -- 72.27) vs P with MS = 3.91 (3.91 -- 3.91) vs C = 3.91 (3.91 -- 28.8), p = 0.53; culture 48 hours without stimulus: P with SS = 3.91 (3.91 -- 3.91) vs P with MS = 3.91 (3.91 -- 86.8) vs C = 3.91 (3.91 -- 53.3), p = 0.55; culture 48 hours with stimulus: P with SS = 241.8 (3.91 -- 2200) vs P with MS = 217.5 (3.91 -- 1346) vs C = 154.3 (3.91 -- 1353), p = 0.7. Conclusions: There were no differences in concentrations of IL 17 according to severity of coronary stenosis, does not matter in serum or cell in culture. In conclusion, there was no association between severity of coronary stenosis and IL 17 in patients with stable CAD

Abstract 2872: Interleukin-18/interleukin-10 Ratio is an Independent Predictor of Cardiovascular Events in Patients with Stable Coronary Artery Disease

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Paulo V Camargo ◽  
Raquel M Roman ◽  
Ana Paula W Rossini ◽  
Anderson Dedonelli ◽  
Steffan F Stella ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Inflammatory Cytokine ◽  
Stable Coronary Artery Disease ◽  
Vascular Event ◽  
Coronary Syndrome ◽  
Anti Inflammatory ◽  
Hs Crp ◽  
Artery Disease ◽  
Stable Cad

Background: The balance between pro-inflammatory cytokine IL-18 and anti-inflammatory cytokine IL-10 has been suggested to play a role in atherogenesis and in the prognosis of acute coronary syndrome (ACS). We hypothesized that stable coronary artery disease (CAD) patients have a pro-inflammatory profile prior to an acute event. Methods : A case-control study nested in a cohort of stable CAD patients was performed. Patients were consecutively included and blood samples collected at 3-months intervals. Cases were patients who presented any vascular event (death, ACS, ischemic stroke, peripheral arterial occlusion and revascularization) and controls were retrieved from a sequential list, in a 1:2 ratio, after 22 ± 9 months of follow-up. Serum hs-CRP, interleukin (IL)-10, IL-18 were measured in two serial samples, collected before the events. Results : Among 176 CAD patients, 42 developed a vascular event (cases) and 76 were selected to the control group. Serum levels of IL-18 were significantly higher among cases (411 ± 185 vs. 340 ± 133pg/ml; p = 0.037). Hs-CRP levels (5.4 vs. 5.1mg/l), IL-10 (7.4 vs. 7.2pg/ml), and IL-18/IL-10 ratio (66 vs. 61) were not different between cases and controls in both samples. Cox regression analysis showed that IL-18 levels (HR 1.75 (0.89 –3.5;p = 0.11) and IL-18/IL-10 ratio (HR 1.97; 1.0 –3.8) were predictors of worse prognosis (Figure ). Conclusion: In this study, IL-18 and IL-18/IL-10 ratio were associated with clinical outcomes and support the hypothesis that the balance between pro-inflammatory and anti-inflammatory cytokines may be an important determinant of vascular events in stable CAD patients.

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