Abstract 14375: Plasma Soluble Lectin-like Oxidized Low-density Lipoprotein Receptor-1 as a Novel Prognostic Biomaker in Patients With ST-elevation Acute Myocardial Infarction
Background: Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) appears to play an important role in the atherosclerotic plaque vulnerability and rupture. LOX-1 is cleaved and released as soluble LOX-1 (sLOX-1), and elevated sLOX-1 level may be indicative of plaque instability. sLOX-1 level was shown to be a sensitive and specific biomarker for diagnosing acute coronary syndrome (ACS). Recently, sLOX-1 level was shown to be a reliable prognostic biomarker after ACS. It is unclear how the plasma sLOX-1 level at the acute phase is related to the prognosis in patients with ST-elevation acute myocardial infarction (STEMI).
Methods and Results: We examined the relation between sLOX-1 level at admission and prognosis prospectively in the consecutive 153 STEMI patients admitted within 24 hours after the onset. All patients underwent emergent coronary angiography and 144 were treated with emergent percutaneous coronary intervention. The patients were divided into 2 groups by the median value (71 pg/ml) of plasma sLOX-1 level at admission: those with sLOX-1 level ≤ 71 pg/ml (n=77, LOW) and >71 pg/ml (n=76, HIGH) and followed for median of 1,156 days. None of age, sex, lipid profile or prevalence of diabetes, smoking, hypertension, or Killip class≥ 3 was significantly different between the 2 groups. All-cause mortality and the combined endpoints of major adverse cardiac events (MACE) defined as all-cause mortality and recurrent myocardial infarction were both significantly higher in HIGH than in LOW (25.0% vs 3.9%, p<0.001 and 30.7% vs 9.2%, p=0.005 by Log-rank test, respectively). Even after adjustment for age and left ventricular ejection fraction, a level of sLOX-1 above the median remained an independent predictor of all-cause mortality (adjusted hazard ratio (HR), 7.48; 95% confidence interval (CI): 2.13-26.22, p=0.002) and MACE (adjusted HR, 3.41; 95%CI: 1.41-8.25, p=0.007). As a continuous variable, each 1 pg/ml increase in plasma sLOX-1 was also associated with all-cause mortality (adjusted HR, 1.006; 95%CI: 1.003-1.010, p<0.001) and MACE (adjusted HR, 1.005; 95%CI: 1.002-1.008, p=0.001).
Conclusion: Elevated plasma sLOX-1 at admission independently predicts long-term all-cause mortality and MACE after STEMI.
- © 2013 by American Heart Association, Inc.