Mossmann Márcio, Wainstein Marco Vugman, Mariani Stéfani, Machado Guilherme Pinheiro, de Araújo Gustavo Neves, Andrades Michael, Gonçalves Sandro Cadaval, Bertoluci Marcello Casaccia
Post-Graduate Program in Medical Sciences: Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
Diabetol Metab Syndr. 2022 Aug 26;14(1):125. doi: 10.1186/s13098-022-00891-0.
Interleukin-6 (IL-6) is an inflammation-related cytokine associated with an elevated risk of cardiovascular events. In a previous study, we demonstrated that increased IL-6 was predictive of sub-clinical atherosclerotic coronary disease in intermediate-risk patients undergoing coronary angiography. In the present study, we investigated whether increased serum IL-6 is predictive of cardiovascular events in high-risk patients.
In this observational study, consecutive patients referred for elective coronary angiography due to stable chest pain/myocardial ischemia had IL-6 measured immediately before the procedure. Long-term follow-up was performed by phone call or e-mail, and their clinical registries were revised. The primary outcome was a composite of new myocardial infarction, new ischemic stroke, hospitalization due to heart failure, new coronary revascularization, cardiovascular death, and death due to all causes.
From 141 patients submitted to coronary angiography and IL-6 analysis, 100 had complete follow-up data for a mean of 5.7 years. The median age was 61.1 years, 44% were men, and 61% had type-2 diabetes. The median overall time-to-event for the primary outcome was 297 weeks (95% confidence interval [CI] 266.95-327.16). A receiver operator characteristic curve defined the best cut-off value of baseline serum IL-6 (0.44 pg/mL) with sensitivity (84.37%) and specificity (38.24%) to define two groups. High (> 0.44 pg/mL) IL-6 levels were predictive of cardiovascular events. (p for interaction = 0.015) (hazard ratio = 2.81; 95% CI 1.38-5.72, p = 0.01). Subgroup analysis did not find interactions between patients with or without diabetes, obesity, or hypertension.
In conclusion, an interleukin-6 level higher than 0.44 pg/mL, obtained just before elective coronary angiography, was associated with a poorer prognosis after a mean of 5,7-year. A pre-procedure IL-6 below 0.44 pg/mL, on the other hand, has a very good negative predictive value, suggesting a good prognosis, and may be useful to better indicate coronary angiography in high-risk patients. .
白细胞介素-6（IL-6）是一种与炎症相关的细胞因子，与心血管事件风险升高有关。在先前的一项研究中，我们证明，IL-6升高可预测接受冠状动脉造影的中危患者的亚临床动脉粥样硬化性冠心病。在本研究中，我们调查了血清IL-6升高是否可预测高危患者的心血管事件。
在这项观察性研究中，因稳定型胸痛/心肌缺血而接受择期冠状动脉造影的连续患者在手术前立即检测IL-6。通过电话或电子邮件进行长期随访，并查阅他们的临床记录。主要结局是新发心肌梗死、新发缺血性中风、因心力衰竭住院、新发冠状动脉血运重建、心血管死亡以及所有原因导致的死亡的综合结果。
在141例接受冠状动脉造影和IL-6分析的患者中，100例有完整的随访数据，平均随访时间为5.7年。中位年龄为61.1岁，44%为男性，61%患有2型糖尿病。主要结局的中位总事件发生时间为297周（95%置信区间[CI]266.95-327.16）。受试者工作特征曲线确定了基线血清IL-6的最佳截断值（0.44 pg/mL），其敏感性为84.37%，特异性为38.24%，据此将患者分为两组。高（>0.44 pg/mL）IL-6水平可预测心血管事件。（交互作用p=0.015）（风险比=2.81；95%CI 1.38-5.72，p=0.01）。亚组分析未发现糖尿病、肥胖或高血压患者与非患者之间存在交互作用。
总之，在择期冠状动脉造影前测得的白细胞介素-6水平高于0.44 pg/mL，与平均5.7年后较差的预后相关。另一方面，术前IL-6低于0.44 pg/mL具有非常好的阴性预测价值，提示预后良好，可能有助于更好地指导高危患者进行冠状动脉造影。
