Abstract 13832: Prognostic Value of Plasma Concentration of Soluble Thrombomodulin, a Marker for Endothelial Damage, in Patients Undergoing Elective Coronary Angiography for Suspected Coronary Artery Disease
Background: Thrombomodulin is a transmembrane protein expressed constitutively in endothelial cells. In spite of being mostly located on endothelial cells of arteries, there is, however, a small amount of circulating, soluble TM (sTM). The physiological role of sTM is not fully known, but it is thought to indicate endothelial damage. We prospectively investigated whether increases of plasma sTM levels might be relevant to prognosis in patients with suspected coronary artery disease (CAD).
Methods: We studied 921 consecutive patients (median age, 68 yrs; 696 males) who underwent elective coronary angiography for evaluating CAD. Blood samples for measurements of plasma sTM, D-dimer and total plasminogen activator inhibitor-1 (tPAI-1) were obtained before coronary angiography. Among these patients, 38% had a history of old myocardial infarction, 34% had diabetes, 69% had significant stenosis (>75%) of the coronary artery, and 43% had multi-vessel disease.
Results: A close correlation (r = 0.56, p < 0.0001) was observed between the logarithmic values of sTM and estimated glomerular filtration rate (GFR). During a mean follow-up period of 1054 days, there were 47 (5.1%) overall deaths, including 12 cardiovascular deaths. Comparably, non-survivors were older (median, 74 vs. 68 yrs, p = 0.003), had higher levels of sTM (20.9 vs. 17.0 U/ml, p = 0.004) and D-dimer (0.81 vs. 0.44 μ g/ml, p = 0.001), and displayed a lower level of estimated GFR (65 vs. 68 ml/min/1.73m2, p = 0.02) than survivors. On a stepwise Cox regression analysis including 12 clinical and angiographic variables, quartiles of sTM was independently associated with overall death (relative risk 1.65, P = 0.0009). Mortality rates according to quartiles of sTM were shown in Table.
Conclusion: Increases of sTM may be independently associated with adverse outcomes in patients with suspected CAD. Measurements of sTM may be useful for the risk stratification of mortality in this population.
- © 2012 by American Heart Association, Inc.