Abstract
Cytokines play an important role in ischemic injury and repair. However, little is known about their prognostic value in cardiovascular disease. The aim of this study was to investigate the prognostic importance of chemokines CCL3/MIP-1α, CCL5/RANTES and CCL18/PARC for the risk of future cardiovascular events in patients with acute coronary syndromes (ACS). Baseline levels of CCL3/MIP-1α, CCL5/RANTES and CCL18/PARC were determined in ACS patients from the Bad Nauheim ACS II registry (n = 609). During the following 200 days, patients were monitored for the occurrence of fatal and non-fatal cardiovascular events. Patients with CCL3/MIP1α, CCL5/RANTES and CCL18/PARC concentrations in the highest tertile were associated with an increased risk of a fatal event during follow-up (HR: 2.19, 95%CI: 1.04–4.61 for CCL3/MIP1α, HR: 3.45, 95%CI: 1.54–7.72 for CCL5/RANTES and HR: 3.14, 95%CI: 1.33–7.46 for CCL18/PARC). This risk was highest for patients with all three biomarkers concentrations in the upper tertile (HR: 2.52, 95%CI: 1.11–5.65). Together with known risk predictors of cardiovascular events, CCL3/MIP-1α, CCL5/RANTES and CCL18/PARC combined improved the c-statistics from 0.74 to 0.81 (p = 0.007). In conclusion, CCL3/MIP-1α, CCL5/RANTES and CCL18/PARC are independently associated with the risk of short-term mortality in ACS patients. Combining all three biomarkers further increased their prognostic value.
Highlights
Cardiovascular diseases continue to be a major cause of morbidity and mortality in Western societies [1]
In an effort to study the potential of chemokine markers for risk stratification in acute coronary syndromes (ACS), we examined the prognostic value of baseline levels of CCL3/MIP-1a, CCL5/RANTES and CCL18/PARC in a prospective cohort of 762 ACS patients
High levels of CCL3/MIP1a, CCL5/RANTES and CCL18/ PARC were found to be independently associated with short-term fatal events in patients with ACS
Summary
Cardiovascular diseases continue to be a major cause of morbidity and mortality in Western societies [1]. Evident cardiovascular disease is generally attributable to atherothrombosis and often manifests itself by acute coronary syndromes, such as unstable angina pectoris (UAP) and acute myocardial infarction (AMI). ACS patients have a considerably increased risk of secondary cardiovascular events during follow-up, including recurrent ischemia, myocardial (re)infarction, stroke, embolization and (re)stenosis-related stable angina pectoris. For adequate treatment and patient monitoring it is pivotal to distinguish between individuals with a low and a high risk of secondary events. This risk stratification has long relied on demographic and other classic patient factors [2,3], but is increasingly supported by several biomarkers, such as troponin T (TnT) and C-reactive protein (CRP) [4,5]. The markers performance of predicting future risk at the level of the patient is only moderate and warrants further investigation into new prognostic biomarkers
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