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The role of inflammation in the progression of coronary artery disease (CAD), even in the absence of myocardial necrosis is often overlooked. This increased our interest to evaluate the prognostic value of the inflammatory marker, IL-6 in young patients with ACS and evaluating its role in predicting CAD severity, clinical course and mortality.
A total of 140 young patients (18-40 years old) presented with acute chest pain, were included in this randomized prospective study. They were subjected to a) full clinical evaluation including Kilip class evaluation, b) Laboratory evaluation including cardiac markers and IL-6 level analysis c) 12 leads ECG and Echocardiography and d) coronary angiography. The patients were divided into 2 groups, patients with acute chest pain and positive coronary angiography (110 patients), and those with normal coronary angiography (control group, 30 patients).
The IL-6 level was significantly higher in patients with documented CAD compared to the control group (39.56±2.5 Vs 3.83±0.79 p<0.001). Detailed evaluation of the coronary angiography results showed IL-6 level was significantly higher in patients with significant lesions who needed to perform PCI (92 patients) than patients with non-significant atherosclerotic plaques needing just medical treatment (18 patients) (45.5±23.17 Vs 9.22±1.93 p<0.001). Clinical Comparison of the diversity of the ACS patients showed higher level of IL-6 in STEMI patients (63 Pts 57%) than NSTEMI (23 Pts 21%) and UA (24 Pts 22%) (49.56±23 Vs 43.5±17 Vs 9.5±2.53 respectively with p<0.001). There was positive correlation between IL-6 level and number of affected vessels (r=0.341, p<0.001), and highly significant negative correlation between IL-6 level and TIMI Flow (Pre PCI) (r = - 0.348, p< 0.001). ROC curve was calculated for the use of IL-6 level as a predictor of morbidity and mortality with cutoff value of 41 pg/ml with a sensitivity of 100 %, specificity of 66%, and positive predictive value of 25%, negative predictive value of 100% and the diagnostic accuracy of 69 %. The optimal cutoff value for IL-6 level to predict mortality was 71 pg/ml with a sensitivity of 100%, specificity of 89 %, positive predictive value = 20 %, negative predictive value = 100 % and the diagnostic accuracy = 89 %.
The use of IL-6 as a prognostic marker for ACS may be of Value; it may predict the severity of CAD as well as the mortality and morbidity of young patients with acute coronary syndrome.