García-Salas J M, Tello-Montoliu A, Manzano-Fernández S, Casas-Pina T, López-Cuenca A, Pérez-Berbel P, Puche-Morenilla C, Martínez-Hernández P, Valdés M, Marín F
Department of Clinical Analysis, University Hospital Virgen de la Arrixaca, Murcia, Spain.
Int J Clin Pract. 2014 Mar;68(3):294-303. doi: 10.1111/ijcp.12245. Epub 2013 Dec 22.
Risk stratification in acute coronary syndrome without ST-segment elevation (NSTE-ACS) and troponin-negative remains a challenge. We evaluated the value of interleukin-6 (IL-6) and amino-terminal pro-B-type natriuretic peptide (NT-proBNP) in the prognosis assessment of low-moderate risk NSTE-ACS and troponin-negative, and whether these biomarkers could improve the predictive performance of the established thrombolysis in myocardial infarction (TIMI) risk score.
A total of 212 low-moderate risk patients with NSTE-ACS and troponin-negative were prospectively studied. Clinical follow up at 6 months was performed for adverse endpoints.
A total of 28 patients (13.5%) presented adverse clinical events. Those with adverse clinical events were associated with higher levels of IL-6 [8.58 (5.13-20.95) ng/l vs. 6.12 (4.16-9.14) ng/l, p = 0.043] and NT-proBNP [275.3 (108.6-548.2) ng/l vs. 126.8 (55.97-430.20) ng/l, p = 0.046]. In moderate risk group, we observed a higher event rate in patients with troponin-negative but elevated levels of IL-6 (p = 0.024). Only elevated IL-6 (> 12.40 ng/l) was an independent predictor of adverse outcomes [hazard ratios: 3.62, 95% confidence interval (CI) 1.69-7.75, p = 0.001]. The addition of IL-6 and history of ischaemic heart disease (IHD) to TIMI risk score significantly improved both the discrimination (integrated discrimination improvement, p = 0.003) and reclassification (Clinical Net reclassification improvement, p = 0.010) of the model for adverse events.
Interleukin-6 is an independent predictor of adverse events in low-moderate risk patients with NSTE-ACS and troponin-negative. Its use identifies a higher risk population in moderate-risk patients. This provides together with history of IHD a better discrimination and reclassification beyond that achieved with clinical risk variables from TIMI risk score in these patients.
对非ST段抬高型急性冠脉综合征（NSTE-ACS）且肌钙蛋白阴性患者进行危险分层仍然是一项挑战。我们评估了白细胞介素-6（IL-6）和氨基末端B型利钠肽原（NT-proBNP）在低中危NSTE-ACS且肌钙蛋白阴性患者预后评估中的价值，以及这些生物标志物是否能改善已确立的心肌梗死溶栓（TIMI）危险评分的预测性能。
前瞻性研究了总共212例低中危NSTE-ACS且肌钙蛋白阴性的患者。对不良终点进行6个月的临床随访。
共有28例患者（13.5%）出现不良临床事件。发生不良临床事件的患者IL-6水平较高[8.58（5.13 - 20.95）ng/l对6.12（4.16 - 9.14）ng/l，p = 0.043]，NT-proBNP水平也较高[275.3（108.6 - 548.2）ng/l对126.8（55.97 - 430.20）ng/l，p = 0.046]。在中危组中，我们观察到肌钙蛋白阴性但IL-6水平升高的患者事件发生率更高（p = 0.024）。仅IL-6升高（> 12.40 ng/l）是不良结局的独立预测因素[风险比：3.62，95%置信区间（CI）1.69 - 7.75，p = 0.001]。将IL-6和缺血性心脏病（IHD）病史添加到TIMI危险评分中，显著改善了不良事件模型的辨别能力（综合辨别改善，p = 0.003）和重新分类能力（临床净重新分类改善，p = 0.010）。
白细胞介素-6是低中危NSTE-ACS且肌钙蛋白阴性患者不良事件的独立预测因素。它的应用可识别中危患者中更高风险的人群。这与IHD病史一起，在这些患者中提供了比TIMI危险评分中的临床风险变量更好的辨别能力和重新分类能力。
