Abstract
PurposeStudies have reported an association between low levels of natural immunoglobulin M antibodies against phosphorylcholine(IgM anti-PC) and worse prognosis in patients with coronary artery disease (CAD). The aims of the present study were, in patients with ST-elevation myocardial infarction (STEMI); 1) to compare serum levels of IgM anti-PC measured acutely and after 3 months; 2) to study an association between levels of IgM anti-PC and the severity ofCAD, and; 3) to investigate whether IgM anti-PC levels are associated with long-term clinical outcome.MethodsA total of 213 patients without known diabetes (median age 59 years) with a PCI treated STEMI were enrolled. IgM anti-PC was measured in-hospital and after 3 months. Median follow-up time was 6.5 years (all-cause mortality, non-fatal myocardial re-infarction, recurrent ischemia causing hospital admission, heart failure and stroke). The severity of CAD was evaluated by coronary angiograms and patients were classified as having single- or multi-vessel disease and by SYNTAX score (SXscore).ResultsIgM anti-PC levels were stable over time when measured acutely and after 3 months. Patients with multi-vessel disease and high SXscore had significantly lower levels of IgM anti-PC in the acute phase of STEMI. Low levels of IgM anti-PC (the 25 percentile) measured acutely were associated with a 2-fold increase in the odds of having multi-vessel disease (adjusted OR 2.28 (95% CI 1.17, 4.44), p = 0.016), but not with high SXscore (Crude OR 2.20 (95% CI 0.96, 5.07), p = 0.06). Fifty-three patients experienced a new clinical event during long-term follow-up. Low levels of IgM anti PC were not associated with worse prognosis, (crude HR 1.54 (0.87–2.76), p = 0.14).ConclusionSTEMI patients with multi-vessel disease or high SXscore had significantly lower levels of IgM anti-PC in the acute phase and low levels were associated with multi-vessel disease, but not with worse clinical outcome during long-term follow-up.
Highlights
The atherosclerotic process leading to plaque rupture and coronary occlusion is the leading underlying cause of myocardial infarction and sudden cardiac death, and atherosclerosis is considered at least partly to be an inflammatory disease [1,2,3]
IgM anti-PC in STEMI patients disease (adjusted OR 2.28, p = 0.016), but not with high SYNTAX score (SXscore) (Crude OR 2.20, p = 0.06)
Low levels of IgM anti PC were not associated with worse prognosis, (crude HR 1.54 (0.87–2.76), p = 0.14)
Summary
The atherosclerotic process leading to plaque rupture and coronary occlusion is the leading underlying cause of myocardial infarction and sudden cardiac death, and atherosclerosis is considered at least partly to be an inflammatory disease [1,2,3]. Phosphorylcholine (PC) is a known oxidationspecific epitope on oxidized low-density lipoprotein (OxLDL) and natural immunoglobulin M (IgM) antibodies against PC (IgM anti-PC) may have atheroprotective properties in response to oxidative stress [4]. Little is known about the levels of IgM anti-PC during an acute ST-elevation myocardial infarction (STEMI), how levels change in patients post-MI, or a possible association between levels of IgM anti-PC measured acutely and the extent of coronary artery disease, or new clinical events after STEMI. The aims of the present study were ; in patients with STEMI 1) to compare serum levels of IgM anti-PC measured acutely with measurements after 3 months; 2) to study a possible association between levels of IgM anti-PC and the severity of coronary artery disease, and; 3) to investigate whether IgM anti-PC levels are associated with long-term clinical outcome
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