Abstract 2611: Prognostic Value Of The Soluble PlGF Receptor sFlt-1 In Patients Presenting With An Acute Coronary Syndrome
Background In recent years it has been found, that angiogenetic factors like the placental growth factor (PlGF, a member of the VEGF family) provide strong prognostic information. However, no data are available for the relevance of the soluble PlGF receptor (sFlt-1, VEGF-R1). Therefore it was our aim to investigate the prognostic value of sFlt-1 in patients presenting with ACS.
Methods and results 1136 consecutive patients (age 64±12 years; 347 females) with an ACS within the last 48 hours were included. Follow up data were available for 1128 (99.3%) patients. Serum samples on admission were available for 1096 (97%) patients and from 821 (72%) patients a second sample the day following admission. Values of sFlt-1 and PlGF on admission were elevated and declined from admission to day 1 (777 vs. 99 pg/ml; p<0.001 and 22.2 vs. 17.2 pg/ml; p<0.001). During follow up 77 (6.8%) patients deceased. There was no difference of PlGF levels on admission and at day 1 between patients who survived and those who deceased (22.8 vs. 23.5 pg/ml, p=0.87 and 17.2 vs. 18.1 pg/ml, p=0.14). In contrast sFlt-1 levels measured at day 1 of patients who died during follow up were significantly higher as compared to patients who survived (215 vs. 96 pg/ml; p<0.001). Mortality rate increased continuously with increasing quartiles of sFlt-1 values (1.0%; 1.0%; 4.9% und 13.6%). The AUC of the ROC curve for sFlt-1 as a predictor for mortality was 0.801 (p<0.001) and in Kaplan-Meier survival analysis there was a significant difference in mortality in relation to sFlt-1 levels (Log Rank 46, p<0.001) . A significant association of sFlt-1 dichotomized at the median to the mortality rate was present independently of troponin values. (0.7% vs. 6.8%; p=0.013 in torponin T negative patients and 1.1% vs. 10.3%; p<0.001 in troponin T positive patients).
Conclusions Assessment of the soluble PlGF receptor sFlt-1 provides prognostic information which is superior to PlGF assessment. Thus sFlt-1 is a promising new biomarker for risk stratification of patients with an ACS. The mechanisms leading to an increase of sFlt-1 values in the acute phase are not fully elucidated. However, the observed release kinetic of sFlt-1 suggests that myocardial ischemia might be a trigger for sFlt-1 release.