Inflammatory Markers as Predictors of Atherosclerotic Plaque Burden and Future Major Adverse Cardiovascular Events: Insights from a Tertiary Care Centre of Southeast Asia

Globally, coronary artery disease (CAD) remains the principal cause of death and disability, with India accounting for one fifth of the global CAD mortalities, and a decade lower age of onset. Inflammation forms the key pathophysiology of CAD progression. The present prospective cohort study recruited 244 ACS patients and 187 age-matched healthy controls, after seeking written informed consent. Serum IL6, MPO, and homocysteine were analyzed using ELISA and hsCRP was estimated in autoanalyzer. Serum fatty acid methyl esters were estimated in GCMS platform. Clinical history and laboratory data were retrieved from electronic medical records, and the participants were followed for 18 months. Out of 244 recruited ACS patients, two thirds of the participants were males. IL6, hsCRP, MPO, NLR, LMR, PLR and SII showed statistically significant differences between cases and controls. Baseline IL6, hsCRP, NLR, SII showed significant difference between ACS subgroups, IL6 and hsCRP showed significant correlation with clinical scores, NLR and SII showed significant correlation with angiographic scores. Elevated baseline IL6, MPO and hsCRP emerged as significant predictors of MACE and heart failure. Baseline methyl palmitate and linoleate showed significant reductions in ACS participants showing MACE. The inflammatory markers significantly correlated with clinical and angiographic scores. Baseline PLR & SII showed good specificity for predicting future MACE. Baseline hsCRP, MPO, NLR, PLR & LMR showed good sensitivity for ruling out the risk of future heart failure.