Diagnostic Impact of Hs-CRP and IL-6 for Acute Coronary Syndrome in Patients Admitted to the ED with Chest Pain: Added Value to the HEART Score?

Abstract

Khalil Rafiqi,1,2 Camilla Bang Hoeks,3 Bo Løfgren,3,4 Martin Bødtker Mortensen,5,6 Jens M Bruun1,4 1Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark; 2Emergency Department, Aarhus University Hospital, Aarhus, Denmark; 3Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark; 4Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; 5Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; 6Ciccarone Center for Prevention of Heart Disease, Johns Hopkins, Baltimore, MD, USACorrespondence: Khalil Rafiqi, Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Blvd. 11, Indgang A, Aarhus, 8200, Denmark, Email [email protected]: To investigate whether hs-CRP and IL-6 provide additional diagnostic value beyond that achieved by the HEART score in patients with chest pain suggestive of acute coronary syndrome (ACS) admitted to the emergency department (ED).Methods: This was a post hoc analysis using data from the RACING-MI study. Baseline data, including hs-CRP and IL-6 levels, were analyzed using the plasma from the biobank. A total of 818 patients with chest pain suggestive of ACS were included in this analysis. Of these, 98 were diagnosed with ACS (12%). Logistic regression was used to identify the independent predictors of ACS development in patients with chest pain.Results: hs-CRP levels > 2 mg/L were observed in 50% of all ACS cases. IL-6 levels > 1.3 pg/mL were observed in 71% of all ACS cases. hs-CRP had a sensitivity of 50% and specificity of 51% for the diagnosis of ACS, whereas IL-6 had a sensitivity of 71% and specificity of 29%. The diagnostic likelihood ratios for ACS was 1.0 for hs-CRP> 2 mg/L and IL-6 > 1.3 pg/mL, respectively. Logistic regression analysis revealed that age, male gender, and ongoing smoking were associated with ACS in patients with acute chest pain. No association was found between IL-6 or hs-CRP level and ACS. This was observed for both IL-6 and hs-CRP, whether assessed on a continuous scale or using prespecified cut-off values.Conclusion: Among the 818 patients admitted to the ED with chest pain suggestive of ACS, neither hs-CRP nor IL-6 provided an independent added diagnostic value. Our results suggest that inflammatory markers have limited diagnostic value in detecting patients with ACS in the ED.Keywords: admission hs-CRP and IL-6 values, HEART-score, acute coronary syndrome, diagnosis

Keywords

• admission hs-crp and il-6 values
• heart-score
• acute coronary syndrome
• diagnosis