Abstract 13941: Plasma Monocyte Chemoattractant Protein Level Predicts Long-Term Adverse Cardiovascular Outcomes in Patients With Stable Coronary Artery Disease
Background: Monocyte Chemoattractant Protein (MCP-1) mediates recruitment of monocytes and is pathophysiologically important in the development of atherosclerosis. Plasma MCP-1 levels predicts adverse cardiovascular outcomes in patients with acute coronary syndrome, however, its prognostic role in patients with stable CAD remains unknown.
Methods: 200 patients with stable CAD (Age: 61±10, 83% male, 45% diabetic) underwent coronary stenting. Plasma CRP and MCP-1 were measured before and after angioplasty. Patients were followed for CV death and/or myocardial infarction (MI) for a median of 6.7 yrs. Cox proportional hazard was used to determine independent predictors of CV death/MI. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were calculated.
Results: Plasma MCP-1 significantly increased the day after PCI and remained elevated for a 1 month (baseline: 136±63 vs. 1 day: 177±84, vs. 1 month: 159±75 pg/ml, p<0.001 for both). During follow-up, 24% (N=48) of the subjects suffered death or MI. Independent predictors of CV death/MI were levels of CRP (HR: 1.03, P=0.008), MCP-1 (HR=1.007, P=0.009), and creatinine (p<0.001) after adjustment of all conventional risk factors. A composite risk score based on whether 0, 1, or 2 biomarkers were raised above cutoff value determined using Youden’s index revealed that compared to those with risk score of 0, the hazard ratio (HR) for CV death/MI was 1.72 (p=0.16) and 4.3 (p=0.003) for those with scores of 1 and 2, respectively. Discrimination analyses demonstrated significant improvements in NRI [0.51 (0.19-0.84)], and IDI [0.03 (0.0006, 0.065)].
Conclusion: Plasma MCP-1 level increases after vascular injury. MCP-1 level is a significant predictor of long-term CV outcome in stable CAD after adjustment for conventional risk factors and CRP. A composite index of both MCP-1 and CRP significantly predicts CV mortality and MI during follow-up and improves risk classification.
- © 2013 by American Heart Association, Inc.