Abstract 3075: Evaluation of Monocyte Chemoattractant Protein 1 as a Prognostic Marker in the A to Z Trial
Background: Monocyte chemoattractant protein (MCP)-1 is a chemokine recruiting signal for monocytes that may function as both a mediator and biomarker of ACS. We assessed whether this novel marker adds prognostic value to standard risk assessment tools in ACS.
Methods: Plasma levels of MCP-1 were measured at baseline (n=4244) and 4 months (n=3600) and correlated with subsequent clinical events in patients with ACS enrolled in the Z phase of the A to Z trial, which randomized patients to early intensive vs delayed and less intensive statin therapy. We also evaluated the influence of simvastatin 40/80 mg vs placebo on MCP-1 levels at 4 months following ACS.
Results: The primary A to Z endpoint of death, MI, readmission for ACS, and stroke increased across quartiles of MCP-1 measured either at baseline (p trend < 0.0001, figure⇓) or 4 months (p trend =0.007). Death and the composite of death or MI also increased across baseline and 4 month MCP-1 quartiles (p trend<0.01 for each). In multivariable analyses adjusting for age, sex, diabetes, prior MI, index diagnosis, treatment assignment, creatinine clearance, LDL, hs-CRP, and BNP, a baseline MCP-1 level in the 3rd or 4th quartile remained associated with death and the composite of death or MI (p≤0.01 for each). Patients randomized to simvastatin 40/80 mg had modestly lower MCP-1 levels at 4 months than those randomized to placebo (median 206 vs 213 pg/mL, p=0.005).
Conclusions: MCP-1 provides independent prognostic value in ACS and merits further evaluation as a prognostic marker and potential therapeutic target in ACS. The influence of intensive statin therapy on MCP-1 levels is modest.