Journal article
Amyloid-β (1-40) and Mortality in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome: A Cohort Study.
- Stamatelopoulos K Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece (K.S., G.G., F.A.).
- Mueller-Hennessen M University Hospital Heidelberg and German Center for Cardiovascular Research, Heidelberg, Germany (M.M., M.B., M.V., H.A.K., E.G.).
- Georgiopoulos G Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece (K.S., G.G., F.A.).
- Sachse M Institute of Cardiovascular Regeneration at Goethe University Frankfurt and German Center for Cardiovascular Research, Frankfurt, Germany (M.S., A.G., S.D.).
- Boeddinghaus J Cardiovascular Research Institute Basel and University Hospital of Basel, Basel, Switzerland (J.B., P.B., T.N., C.M.).
- Sopova K German Center for Cardiovascular Research and Goethe University Frankfurt, Frankfurt, Germany (K.S., A.M.Z.).
- Gatsiou A Institute of Cardiovascular Regeneration at Goethe University Frankfurt and German Center for Cardiovascular Research, Frankfurt, Germany (M.S., A.G., S.D.).
- Amrhein C Institute of Cardiovascular Regeneration at Goethe University Frankfurt, Frankfurt, Germany (C.A.).
- Biener M University Hospital Heidelberg and German Center for Cardiovascular Research, Heidelberg, Germany (M.M., M.B., M.V., H.A.K., E.G.).
- Vafaie M University Hospital Heidelberg and German Center for Cardiovascular Research, Heidelberg, Germany (M.M., M.B., M.V., H.A.K., E.G.).
- Athanasouli F Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece (K.S., G.G., F.A.).
- Stakos D Democritus University of Thrace, Alexandroupolis, Greece (D.S.).
- Pateras K Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (K.P.).
- Twerenbold R Cardiovascular Research Institute Basel and University Hospital of Basel, Basel, Switzerland, and University Heart Center Hamburg, Hamburg, Germany (R.T.).
- Badertscher P Cardiovascular Research Institute Basel and University Hospital of Basel, Basel, Switzerland (J.B., P.B., T.N., C.M.).
- Nestelberger T Cardiovascular Research Institute Basel and University Hospital of Basel, Basel, Switzerland (J.B., P.B., T.N., C.M.).
- Dimmeler S Institute of Cardiovascular Regeneration at Goethe University Frankfurt and German Center for Cardiovascular Research, Frankfurt, Germany (M.S., A.G., S.D.).
- Katus HA University Hospital Heidelberg and German Center for Cardiovascular Research, Heidelberg, Germany (M.M., M.B., M.V., H.A.K., E.G.).
- Zeiher AM German Center for Cardiovascular Research and Goethe University Frankfurt, Frankfurt, Germany (K.S., A.M.Z.).
- Mueller C Cardiovascular Research Institute Basel and University Hospital of Basel, Basel, Switzerland (J.B., P.B., T.N., C.M.).
- Giannitsis E University Hospital Heidelberg and German Center for Cardiovascular Research, Heidelberg, Germany (M.M., M.B., M.V., H.A.K., E.G.).
- Stellos K Cardiovascular Research Centre, Institute of Genetic Medicine, Newcastle University and Cardiothoracic Centre, Newcastle upon Tyne Hospitals, NHS Foundation Trust, Newcastle upon Tyne, United Kingdom (K.S.).
- 2018-05-26
Published in:
- Annals of internal medicine. - 2018
Acute Coronary Syndrome
Aged
Amyloid beta-Peptides
Biomarkers
Female
Humans
Male
Peptide Fragments
Prognosis
Retrospective Studies
Risk Factors
English
Background
Amyloid-β (1-40) (Aβ40) is implicated in mechanisms related to plaque destabilization and correlates with adverse outcomes in stable coronary artery disease.
Objective
To determine the prognostic and reclassification value of baseline circulating levels of Aβ40 after adjustment for the Global Registry of Acute Coronary Events (GRACE) score, which is widely recommended for risk stratification in non-ST-segment elevation acute coronary syndrome (NSTE-ACS).
Design
Retrospective cohort study using data from 2 independent prospective cohorts, the Heidelberg study (n = 1145) and the validation multicenter international APACE (Advantageous Predictors of Acute Coronary Syndrome Evaluation) study (n = 734).
Setting
Academic hospitals in 7 European countries.
Participants
Patients with adjudicated NSTE-ACS followed for a median of 21.9 and 24.9 months in the Heidelberg and APACE studies, respectively.
Measurements
All-cause mortality was the primary end point.
Results
Amyloid-β (1-40) was associated with mortality after multivariate adjustment for age, sex, diabetes mellitus, high-sensitivity cardiac troponin T and C-reactive protein, revascularization, and ACS type (Heidelberg cohort hazard ratio [HR] for 80th vs. 20th percentiles, 1.66 [95% CI, 1.06 to 2.61; P = 0.026]; APACE cohort HR, 1.50 [CI, 1.15 to 1.96; P = 0.003]). It was also associated with mortality after adjustment for the GRACE score (Heidelberg cohort HR for 80th vs. 20th percentiles, 1.11 [CI, 1.04 to 1.18; P = 0.001]; APACE cohort HR, 1.39 [CI, 1.02 to 1.88; P = 0.036]). Amyloid-β (1-40) correctly reclassified risk for death over the GRACE score (net reclassification index, 33.4% and 47.1% for the Heidelberg and APACE cohorts, respectively) (P < 0.05).
Limitation
At low concentrations of Aβ40, dose-response associations with mortality differed between cohorts, possibly because of varying blood preparations used to measure Aβ40.
Conclusion
Circulating Aβ40 is a predictor of mortality and improves risk stratification of patients with NSTE-ACS over the GRACE score recommended by clinical guidelines. The clinical application of Aβ40 as a novel biomarker in NSTE-ACS should be further explored and validated.
Primary Funding Source
German Cardiac Society.
Amyloid-β (1-40) (Aβ40) is implicated in mechanisms related to plaque destabilization and correlates with adverse outcomes in stable coronary artery disease.
Objective
To determine the prognostic and reclassification value of baseline circulating levels of Aβ40 after adjustment for the Global Registry of Acute Coronary Events (GRACE) score, which is widely recommended for risk stratification in non-ST-segment elevation acute coronary syndrome (NSTE-ACS).
Design
Retrospective cohort study using data from 2 independent prospective cohorts, the Heidelberg study (n = 1145) and the validation multicenter international APACE (Advantageous Predictors of Acute Coronary Syndrome Evaluation) study (n = 734).
Setting
Academic hospitals in 7 European countries.
Participants
Patients with adjudicated NSTE-ACS followed for a median of 21.9 and 24.9 months in the Heidelberg and APACE studies, respectively.
Measurements
All-cause mortality was the primary end point.
Results
Amyloid-β (1-40) was associated with mortality after multivariate adjustment for age, sex, diabetes mellitus, high-sensitivity cardiac troponin T and C-reactive protein, revascularization, and ACS type (Heidelberg cohort hazard ratio [HR] for 80th vs. 20th percentiles, 1.66 [95% CI, 1.06 to 2.61; P = 0.026]; APACE cohort HR, 1.50 [CI, 1.15 to 1.96; P = 0.003]). It was also associated with mortality after adjustment for the GRACE score (Heidelberg cohort HR for 80th vs. 20th percentiles, 1.11 [CI, 1.04 to 1.18; P = 0.001]; APACE cohort HR, 1.39 [CI, 1.02 to 1.88; P = 0.036]). Amyloid-β (1-40) correctly reclassified risk for death over the GRACE score (net reclassification index, 33.4% and 47.1% for the Heidelberg and APACE cohorts, respectively) (P < 0.05).
Limitation
At low concentrations of Aβ40, dose-response associations with mortality differed between cohorts, possibly because of varying blood preparations used to measure Aβ40.
Conclusion
Circulating Aβ40 is a predictor of mortality and improves risk stratification of patients with NSTE-ACS over the GRACE score recommended by clinical guidelines. The clinical application of Aβ40 as a novel biomarker in NSTE-ACS should be further explored and validated.
Primary Funding Source
German Cardiac Society.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.7326/M17-1540
- PMID 29799975
- Persistent URL
- https://folia.unifr.ch/global/documents/8730
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