eng Oriental Scientific Publishing Company Biomedical and Pharmacology Journal 0974-6242 2017-09-25 10 3 1229 1238 10.13005/bpj/1225 16367 article Ketut Suryana 1 Wayan Wita 2 I. Gde Raka Widiana 3 Ketut Suastika 4 I. Wayan Putu Sutirtaya 5 Department of Internal Medicine, University of Udayana, Bali. Department of Cardiology University of Udayana, Bali. Department of Clinical Pathology, Faculty of Medicine, University of Udayana, Bali. 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 ≥ 23.4 pg/ml),  high ratio of IL-6/IL-10 plasma levels  (median ≥ 0.95) and low plasma IL-10 (median < 14.11 pg/ml) showed lower cumulative survival  than controls.  Patients with high plasmaMMP-9 hasashortersurvival by almost1month(27 days) than controls.Cox proportional model showed that high of plasma MMP-9(median ≥ 23.4 pg/ml) had significantassociation 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 mayan independentrisk factor of CVE in ACS. https://biomedpharmajournal.org/vol10no3/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/ Acute Coronary Syndrome Cardiovascular eventsInflammatory forces