Additive prognostic value of interleukin-6 at peak phase of dobutamine stress echocardiography in patients with coronary artery disease. A 6-year follow-up study

• Published in: The American heart journal Vol. 156; no. 2; pp. 269 - 276
• Main Authors: Ikonomidis, Ignatios, MD, Athanassopoulos, George, MD, Stamatelopoulos, Kimon, MD, Lekakis, John, MD, Revela, Ioanna, MD, Venetsanou, Kiriaki, MD, Marinou, Margarita, MD, Monaco, Claudia, MD, Cokkinos, Dennis V., MD, Nihoyannopoulos, Petros, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.08.2008; Elsevier; Elsevier Limited
• Subjects: Acute coronary syndromes; Aged; Biological and medical sciences; Biomarkers; Cardiac Catheterization; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Cardiovascular system; Coronary Artery Disease - blood; Coronary Artery Disease - diagnosis; Coronary Artery Disease - diagnostic imaging; Coronary heart disease; Coronary vessels; Cytokines; Diabetes; Echocardiography, Stress; Female; Follow-Up Studies; Heart; Heart attacks; Heart rate; Humans; Hypertension; Interleukin-6 - blood; Investigative techniques, diagnostic techniques (general aspects); Ischemia; Kaplan-Meier Estimate; Male; Medical sciences; Middle Aged; Multivariate Analysis; Prognosis; Proportional Hazards Models; Regression analysis; ROC Curve; Thromboplastin - analysis; Ultrasonic investigative techniques; Sonography; Human; Pharmacologic test; Echocardiography; Phase; Prognosis; Cardiovascular disease; Coronary heart disease; Interleukin 6; Follow up study; Peak; Circulatory system; Cardiology
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2008.03.020

Background Interleukin-6 (IL-6) and tissue factor (TF) are elevated after myocardial ischemia during dobutamine stress echo (DSE). We examined the incremental prognostic value of IL-6 or TF measured during DSE over echocardiographic and clinical factors in patients with chronic coronary artery disease (CAD). Methods We studied 106 patients with angiographically documented CAD. IL-6 and TF were measured at rest, peak, and during recovery. A wall motion score index was calculated. Results Fifty-seven (54%) patients had ischemia at DSE. During follow-up (63.7 ± 20 months), 36 patients (33%) had an adverse event (12 cardiac deaths, 24 acute coronary events). Patients with events had a higher peak IL-6 ( P = .02) but similar rest and recovery IL-6 than those without. Patients with peak IL-6 ≥3.14 pg/mL (upper tertile) had a hazard ratio of 2.7 (95% CI 1.44-5.37) ( P < .01 for an adverse event). The addition of peak wall motion score index in a multivariable model including risk factors, ejection fraction, revascularization, and multivessel disease increased the model's c statistic from 0.66 to 0.70 ( P = .04). The addition of peak IL-6 further increased the model's c statistic to 0.75 ( P = .04). Tissue factor was not related with cardiac events. Conclusions Interleuikin-6 levels measured during the peak phase of DSE incrementally contribute to risk stratification in patients with chronic CAD.