Abstract 2062: Soluble Flt-1 as an early diagnostic Marker in Acute Coronary Syndromes: Results from the AtheroGene Study
Background Recent data have shown a potential role of the vascular endothelial growth factor family and its fms-like tyrosine kinase (Flt)-1 receptor in acute coronary syndromes (ACS). This study was designed to evaluate the diagnostic and prognostic value of Flt-1 measurement in patients presenting with chest pain.
Methods In 1839 consecutive patients with documented CAD (1096 with stable angina and 743 with ACS) baseline concentrations of soluble Flt-1 were measured along with the classical indicators of ACS troponin I, creatin kinase MB (CK-MB), myoglobin and additionally B-type natriuretic peptide. Biomarker concentrations were evaluated in comparison with 264 control subjects. During a follow-up of 2.5 years cardiovascular events were registered.
Results sFlt-1 concentration peaked early (0 –3 hours) after chest discomfort onset. In comparison with control individuals (median interquartile rangeconcentration: 28.5 (17.7/41.8) ng/ml) sFlt-1 levels were higher in ACS patients (137.3 (51.0/358.9) ng/ml) (p<0.001). sFlt-1 correlated well with troponin I and creatine kinase MB. Further analysis was restricted to patients with non-ST-elevation myocardial infarction and unstable angina. The ROC curve analysis revealed that within the first 6 hours after symptom onset the area under the curve (AUC) for the detection of ACS was highest for sFlt-1 0.91 in comparison with control subjects. For troponin I the AUC was 0.83. Flt-1 was the strongest indicator for the differential diagnosis of unstable angina against normal controls (AUC: 0.92) and stable angina (SAP) patients (AUC: 0.76) within the first 6 hours after symptom onset. This marker was superior to myoglobin (AUC: 0.68 vs. controls and SAP) and CK-MB (AUC: 0.66 vs. controls; 0.68 vs. SAP). No significant association was observed between event free survival and sFlt-1 baseline concentrations.
Conclusion The current prospective study for the first time demonstrates that sFlt-1 is elevated early in acute coronary syndromes and may provide important diagnostic information in the differential diagnosis of acute chest pain in addition to necrosis markers. sFlt-1 levels were not significantly associated with cardiovascular outcome in coronary artery disease.