Inflammatory Cytokines Imbalance in the Very Early Phase of Acute Coronary Syndrome: Correlations with Angiographic Findings and In-Hospital Events

The aim of this study is to investigate the release of some inflammatory cytokines (Cks) during the very early phase (first 24 h) of acute coronary syndrome (ACS). Twenty-six consecutive subjects admitted to coronary care unit with ACS underwent serial blood sampling in order to evaluate concentrations of interleukin (IL)-2, IL-10, IL-18, tumor necrosis factor (TNF)-alpha, and interferon (IFN)-gamma. Blood samples were taken within 6 h after onset of chest pain (T-0), at 12 h (T-1), and at 24 h (T-2). Patients were thus divided into four groups comparing pro-inflammatory Ck release (IL-2, TNF-alpha, and IFN-gamma) and anti-inflammatory activity (IL-10). Clinical features, risk factors, incidence of adverse events, and coronary angiography findings were compared with Ck activation. Ck levels were significantly increased if compared with baseline. Subjects with marked inflammatory response showed a higher incidence of left anterior descending coronary disease (IL-2, p < 0.001; TNF-alpha and IFN-gamma, p < 0.05) and more often incurred early complications (IL-2, p < 0.05; IFN-gamma, p < 0.001). A correlation was detectable between IL-18 levels and myocardial enzyme release (creatine kinase, r = 0.47; lactate dehydrogenase, r = 0.54; troponin I, r = 0.58; p < 0.05). TNF-alpha levels were associated with a worse prognosis at follow-up (Log rank, p < 0.05). A Ck activation characterizes the early phase of ACS. Early inflammatory reaction seems to correlate with coronary disease and adverse events.