Systemic Inflammatory Response Syndrome Predicts Mortality in Acute Coronary Syndrome without Congestive Heart Failure

Abstract

Introduction: High levels of inflammatory biochemical markers are associated with an increased risk among patients with acute coronary syndrome (ACS). The objective of the current study was to evaluate the prognostic significance of the systemic inflammatory response syndrome (SIRS) among ACS patients with no clinical or radiological evidence of congestive heart failure (CHF).

Methods: Consecutive patients with ACS and no clinical or radiological evidence of CHF in the emergency department (ED) were included in the study. The endpoint was hospital mortality. Categorical variables were compared by calculating proportions with 95% confidence intervals (CIs) and by using the Fisher Exact test. Continuous variables were compared by using the Wilcoxon Rank Sum test. The association of the variables with hospital mortality was assessed by using the logistic regression analysis.

Results: The study included 196 patients (60 years; female 32.6 %). Six patients (3.1 %) died in hospital and 22 patients (11.2 %) had SIRS on admission to the ED. The following variables were predictors of hospital mortality: age with an odds ratio (OR) of 1.1 (95% CI, 1-1.2) for each one additional year (p <0.01), systolic arterial pressure with an OR 0.9 (95% CI, 0.9-1), diastolic arterial pressure with an OR 0.9 (95% CI, 0.8-1) for each one additional mmHg (p < 0.01), respiratory rate with an OR 1.5 (95% CI, 1.2-1.9) for each one additional breath per minute (p < 0.01), and SIRS with an OR 9 (95% CI, 1.7-47.8) (p 0.02). Because of the small number of events, it was not possible to assess the independence of these risk factors.

Conclusion: SIRS was a marker of increased risk of hospital mortality among patients with ACS and no clinical or radiological evidence of CHF.