Low IL-10 Plasma Levels, High IL-6 IL-10 Ratio and Matrix Metalloproteinase-9 (MMP-9) Associated with high Cardiovascular Events in Acute Coronary Syndrome

The progression of atherosclerosis in acute coronary syndrome (ACS) may depend on balance of inflammatory and anti-inflammatory cytokines. Aim of this study was to investigate association between low IL-10 plasma levels, high MMP-9, IL-6 / IL-10 plasma ratio and risk of cardiovascular events (CVE) in ACS patients. A prospective cohort study was conducted in Intensive Cardiac Care Unit of Sanglah Hospital in Denpasar. Seventy three ACS were selected consecutively, consisting of patients: 12 (16.4%) UAP patients, 11 (15.1%) NSTEMI patients and 50 (68.5%) STEMI patients. During the 6 months follow-up period, 14 (19.2%) patients had CVE; 10 (13.7%) patients with vascular deaths, 3 (4.1%) patients with IMA and 1 (1.4%) with recurrent cardiac ischemia. In Kaplan-Meier survival curve, showed that group with high plasma MMP-9 (median e” 23.4 pg/ml), high ratio of IL-6/IL-10 plasma levels (median e” 0.95) and low plasma IL-10 (median < 14.11 pg/ml) showed lower cumulative survival than controls. Patients with high plasmaMMP-9 hasa shortersurvival by almost1month(27 days) than controls.Cox proportional model showed that high of plasma MMP-9(median e” 23.4 pg/ml) had significant association with CVE (RR = 6.6; p<0.05), meanwhile, dyslipidemia and hypertension also hadsignificantassociation with CVE (RR 0.2 and 4.1; p-value < 0.001 and 0.04, consecutively). Using path analysis, it was found that effect of IL-10 to CVE is through MMP-9. High MMP-9 may an independent risk factor of CVE in ACS.