Abstract 9388: The ALPACA Study, an EHR Based Analysis of the Association of Elevated Alkaline Phosphatase With Cardiovascular Events

Abstract

Alkaline phosphatase (ALP) has a key role in vascular calcification, a process implicated in cardiovascular (CV) diseases. Previous studies suggest elevated ALP is associated with increased risk of CV events, and that this association is strengthened by elevated baseline bilirubin. The risk of CV events in patients with an acute coronary syndrome (ACS) event is yet to be explored. The analysis was performed on TriNetX, a federated EHR platform of 34 large HCOs in the US. Patients who had an ACS event in 2017-2018 and had an ALP recorded ±30 days were divided by ALP below or above 79 IU/L (approximately 38,000 patients), and ALP below 70 or above 121 IU/L (approximately 12,000 patients). Patients were propensity score matched on comorbidities, laboratory measures and medications. CV outcomes, non-CV outcomes, all-cause hospital admissions and mortality were estimated at 1 year post-ACS event using the Kaplan-Meier method. Elevated ALP was associated with atrial fibrillation and heart failure events. It was also associated with renal progression and infection but not with atherothrombotic events. On top of elevated ALP, elevated bilirubin levels were a key risk driver for these outcomes. Both markers were associated with re-hospitalization and all-cause mortality. This study has confirmed that elevated ALP is strongly associated with heart failure events, re-hospitalization and mortality in ACS patients. Further research on the association between ALP, bilirubin and cardiovascular outcomes is warranted.