Artikel
Lowered anti-beta1 adrenergic receptor antibody concentrations may have prognostic significance in acute coronary syndrome
Suche in Medline nach
Autoren
Veröffentlicht: | 8. Oktober 2019 |
---|
Gliederung
Text
Background: Coronary heart disease is a very common comorbidity in rheumatological diseases. Risk factors predisposing to ACS are well established, but no reliable prognostic biomarkers for post-event survival or risk of reinfarction exist. Physiological levels of antibodies against anti-beta1 adrenergic receptor (anti-β1AR Ab) have been discovered and reduced serum concentrations of anti-β1AR Ab were implicated in a poorer prognosis after ACS. This study explores further the meaning of anti-β1AR-Ab levels at index presentation with ACS.
Methods: Serum anti-β1AR Ab concentrations at event onset were tested in a randomly selected large subset of patients within the PLATO cohort, controlling for ACS event type: ST-elevation myocardial infarct (STEMI) vs. non-ST elevation myocardial infarct (NSTEMI). Patients were divided into those > or < median anti-β1AR Ab concentrations.
Conventional cardiac risk factors, clinical factors, medical history and biomarkers were available for all patients.
Results: Serum anti-β1AR Ab concentrations were measured in the sera from 400/799 (50%) STEMI patients and 399 NSTEMI patients. High levels for anti-β1AR Ab were significantly associated with STEMI (p= 0.001). Considering all ACS patients there was no significant association for anti-β1AR Ab levels regarding all-cause cardiovascular death or reinfarction (p=0.14), whilst STEMI patients aged < 60 years with anti-β1AR Ab concentration < median exhibited a higher rate of reinfarction compared to similarly aged patients with anti-β1AR Ab concentrations > median (16/388 (4,1%) vs. 2/388 (0,5%); p=0.01) and a significantly greater risk for cardiovascular death including reinfarction and stroke (22/388 (5.7%) vs. 5/388 (1,2%); p=0.017). For all STEMI patients, only a trend was identified between low concentrations of anti-β1AR Ab and all-cause cardiovascular death (35/400 (8.7%) vs. 20/400 (15%); p=0.068).
Conclusion: In the large Plato cohort patients ≤ 60 years with an ACS and low concentrations of β1AR Ab had a greater risk for reinfarction and cardiovascular death confirming our previous study. Whilst for all ACS patients we could not see a significant prognostic meaning for anti-β1AR Ab. Therefore, anti-β1AR Ab levels could be prognostic, but need to be further evaluated in larger studies.