Inflammatory markers as predictors in unstable angina

Plasma fibrinogen and C-reactive protein levels have been identified as predictors for cardiac events in patients with stable angina pectoris (ECAT-angina pectoris study), Furthermore, elevated C-reactive protein levels have been associated with a poor outcome in patients with severe unstable angina, These observations indicate the presence of an important inflammatory component in the pathogenesis of the acute stages of coronary artery disease (CAD). Two hundred and eleven consecutive patients that were submitted to our department with unstable angina pectoris were included in the APRAIS study (Acute Phase Reactions And Ischaemic Syndromes). All patients had their last attack within the last 24 hours, and ischaemic ST segment abnormalities on admission or known CAD. The aim of this study is to determine the association between inflammatory processes and the long- and short-term prognosis of the disease. Therefore, markers of chronic inflammation (CRP, interleukin-6, fibrinogen, white blood cell count, ESR), vascular wall function (Von Willebrand Factor, tissue plasminogen activator, plasminogen activator 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%). This 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).