Interleukin-6 and C-reactive protein prognostic value following acute coronary syndrome.
Johan Wouter Jukema, Nicolaas J Van Neer, Michael Szarek et al.
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In 30 seconds
This post hoc prognostic analysis of the multicentre ODYSSEY OUTCOMES randomised trial examined hsCRP and IL-6 in 11,817 patients with recent acute coronary syndrome. Over the trial follow-up, 1,306 patients had a major adverse cardiovascular event (MACE) and 458 died. After adjustment for the other biomarker and clinical factors, hsCRP independently predicted MACE (P < .0001), whereas IL-6 did not (P = .21); both independently predicted all-cause death. The authors report that the markers together provided complementary prognostic information.
Key findings
- Among 11,817 patients, 1,306 experienced MACE and 458 died.
- Adjusted for IL-6 and other factors, hsCRP predicted MACE (P < .0001); IL-6 did not (P = .21).
- Both hsCRP and IL-6 independently predicted all-cause death (P < .0001 and P = .0003, respectively).
- With thresholds of 2 mg/L for hsCRP and 5 pg/ml for IL-6, risks of MACE and death were elevated when both markers were high, but not when only one was.
Why it matters
Inflammatory markers may add prognostic information after acute coronary syndrome beyond lipid levels and clinical factors. These findings distinguish the markers’ associations with outcomes: hsCRP was independently associated with MACE, while both markers were associated with death. Considering them together may help characterize inflammatory risk, although the analysis does not establish that marker-guided decisions improve outcomes.
What to keep in mind
This was a post hoc prognostic analysis of trial data, not a trial of biomarker-guided care; the reported associations do not establish that using these markers to guide treatment improves outcomes.