Abstract 577: Long Pentraxin 3: A New, Independent Marker of Mortality in Acute Chest Pain

Long Pentraxin 3 (PTX3) is a newly identified member of the Pentraxin protein family that includes C-reactive protein (CRP). Unlike CRP, PTX3 is produced by the major cell types involved in atherosclerotic lesions in response to inflammatory stimuli. Increased PTX3 levels are found in acute coronary syndromes (ACS). Its role in long-term prediction of clinical outcome is, however, unknown. The aim of the current study was to assess the predictive value of PTX3 concerning all-cause mortality in patients hospitalized for acute chest pain. Plasma PTX3 was measured with a new, high-sensitive ELISA method (PPMX, Tokyo, Japan) in blood samples taken on admission in 784 patients admitted for acute chest pain suggestive of ACS. The patients were followed for 24 months concerning clinical outcome. For statistical analysis, the study cohort was divided into quartiles according to PTX3 levels. A multiple logistic regression model was fitted to include standard risk measures. At 24 months follow-up 121 patients had died. By logistic regression, the odds Odds Ratio for death among patients with highest PTX3 levels was 3.13 as compared to those with lowest levels (p=0.007) (table). Long Pentraxin 3 is a new, independent marker that strongly predicts long-term all-cause mortality in patients with acute chest pain.

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The long pentraxin 3 (PTX3): a novel prognostic inflammatory marker for mortality in acute chest pain

Thrombosis and Haemostasis ◽

10.1160/th09-02-0137 ◽

2009 ◽

Vol 102 (09) ◽

pp. 555-563 ◽

Cited By ~ 22

Author(s):

Trygve Brügger-Andersen ◽

Volker Pönitz ◽

Harry Staines ◽

Heidi Grundt ◽

Mina Sagara ◽

...

Keyword(s):

Chest Pain ◽

Prognostic Value ◽

Acute Chest Pain ◽

Study Cohort ◽

Consecutive Series ◽

Pentraxin 3 ◽

C Reactive Protein ◽

Death Risk ◽

Reactive Protein ◽

All Cause Mortality

SummaryThe long pentraxin 3 (PTX3) is a recently identified member of the pentraxin protein family that includes C-reactive protein. PTX3 is produced by the major cell types involved in atherosclerotic lesions in response to inflammatory stimuli, and elevated plasma levels are found in several conditions including acute coronary syndromes (ACS). The aim of this study was to assess the value of PTX3 as a prognostic marker of mortality and recurrent ischaemic events in a consecutive series of patients admitted with acute chest pain and potential ACS.The patients received follow-up for 24 months. Blood samples were taken on admission for measurement of PTX3, high sensitive C-reactive protein (hsCRP), B-type natriuretic peptide (BNP), and troponin T. All-cause mortality at 24 months in the study cohort was 15.2%. Patients in the upper PTX3 quartiles had a significantly higher death risk than those in the lowest quartile (Q3: hazard ratio [HR] 2.36; 95% CI 1.12–4.99; p=0.024, and Q4: HR 3.60; 95% CI 1.68–7.72; p=0.001). Elevated BNP levels were also significantly associated with a fatal outcome (Q3: HR 3.05; 95% CI 1.16–7.99; p=0.024; and Q4: HR 3.90; 95% CI 1.48–10.26; p=0.006). Elevation in hsCRP was not associated with increased death risk. As PTX3 predicted mortality independently of BNP, the combination of these two biomarkers showed an incremental prognostic value.PTX3 is a new biomarker related to inflammation that, independently of BNP, strongly predicts long-term all-cause mortality in patients with acute chest pain. The combination of these two biomarkers enhances the prognostic value over either marker alone.

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Soluble urokinase plasminogen activator receptor (suPAR) can predict long-term mortality in patients with acute chest pain

European Heart Journal ◽

10.1093/ehjci/ehaa946.1695 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J Chew-Harris ◽

S Appleby ◽

R.W Troughton ◽

A.M Richards ◽

C.J Pemberton

Keyword(s):

Chest Pain ◽

Acute Chest Pain ◽

Funding Source ◽

Urokinase Plasminogen Activator Receptor ◽

Prognostic Performance ◽

Kaplan Meier ◽

All Cause Mortality ◽

Plasminogen Activator Receptor ◽

Long Term Mortality

Abstract Background Soluble urokinase plasminogen activator receptor (suPAR) is an inflammatory protein associated with plaque instability. Its modulation may reflect on immune dysfunction related to cardiovascular disease burden. We describe the prognostic performance of suPAR in patients presenting with chest pain suspicious of acute myocardial infarction (AMI). Methods suPAR concentrations were measured at presentation using the ViroGates CE-marked ELISA in 812 patients with the primary complaint of acute chest pain. Standard cardiac markers including hsTnT and NT-proBNP (both Roche) were also measured. Data for all biomarkers were treated as continuous and expressed as median [interquartile range (IQR)]. Statistical assessment was made using SPSS v25 (IBM). Groups were compared by Mann-Whitney U test/Spearman's rho. Prognostic performance of suPAR was assessed using receiver operator curve (ROC) area under the curve (AUC), Cox-proportional hazards regression and Kaplan-Meier analyses. Results In this chest pain cohort [median age: 63 yrs (IQR: 54–74), 34% female], 156/812 of patients had adjudicated AMI [STEMI (n=22)/NSTEMI (n=134)]. Total all-cause mortality was 18% within 10 yrs. Although median suPAR concentrations were elevated in AMI patients versus all other diagnoses [3.2 ng/mL (IQR:2.4–4.3) vs 2.7 ng/mL (IQR:2.2–3.6) (P<0.0001)], it did not assist in AMI diagnosis (ROC-AUC=0.60). In the entire chest pain cohort, suPAR (AUC≥0.82) had comparable discrimination to that of NT-proBNP (AUC≥0.84) for the prediction of mortality within 2 yrs (n=52), 4 yrs (n=77) and 10 yrs (n=149), and was better than hsTnT (AUC≤0.70). Addition of suPAR improved the mortality ROC curve of NT-proBNP (0.84 to 0.87) and for hsTnT (0.70 to 0.81) for 2-yr death prediction (Figure). Alone, suPAR was the strongest predictor (AUC=0.77) of new unstable angina at 2-yrs (n=52). The fully adjusted hazard ratio (HR) using Cox models showed suPAR (HR: 1.2) and NT-proBNP (HR: 1.3) to be the only independent biomarkers associated with death at 4 and 10-yrs (P<0.0001). Stratification of baseline suPAR by Kaplan-Meier plots for all-cause mortality showed the highest tertile of suPAR, compared to the lowest, was associated with a HR of 5.7 and 5.1 for 4-yr and 10-yr death, respectively. Conclusion suPAR is a strong prognostic indicator of long-term mortality and its usage alongside current cardiac biomarkers may assist in the risk stratification of AMI patients. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Health Research Council of New Zealand, National Heart Foundation of New Zealand

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Long-term prognostic value of peak exercise echocardiogram in patients hospitalized with acute chest pain

Echocardiography ◽

10.1111/echo.13530 ◽

2017 ◽

Vol 34 (6) ◽

pp. 869-875 ◽

Cited By ~ 1

Author(s):

German Merchan Ortega ◽

Juan Carlos Bonaque Gonzalez ◽

Alejandro Dionisio Sanchez Espino ◽

Maria Jose Aguado Martin ◽

Francisco Navarro Garcia ◽

...

Keyword(s):

Chest Pain ◽

Prognostic Value ◽

Acute Chest Pain ◽

Peak Exercise

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Bronchiectasis and increased mortality in patients with corticosteroid-dependent severe asthma: a nationwide population study

Therapeutic Advances in Respiratory Disease ◽

10.1177/1753466620963030 ◽

2020 ◽

Vol 14 ◽

pp. 175346662096303

Author(s):

Hayoung Choi ◽

Hyun Lee ◽

Jiin Ryu ◽

Sung Jun Chung ◽

Dong Won Park ◽

...

Keyword(s):

Confidence Interval ◽

Respiratory Diseases ◽

Chronic Obstructive ◽

Study Cohort ◽

Limited Information ◽

Term Survival ◽

Obstructive Pulmonary Disease ◽

All Cause Mortality ◽

The Impact

Background: Long-term corticosteroid (CS) use is associated with increased mortality in patients with asthma, and comorbid bronchiectasis is also associated with frequent asthma exacerbation and increased healthcare use. However, there is limited information on whether bronchiectasis further increases mortality in patients with CS-dependent asthma. This study examined the impact of bronchiectasis on mortality in patients with CS-dependent asthma. Methods: A retrospective cohort of patients with CS-dependent asthma ⩾18 years old was established using records from the Korean National Health Insurance Service database from 2005 to 2015. Patients with CS-dependent asthma with and without bronchiectasis were matched by age, sex, type of insurance, and Charlson comorbidity index. We evaluated the hazard ratio (HR) for all-cause mortality in patients with bronchiectasis compared with those without bronchiectasis. Results: The study cohort included 754 patients with CS-dependent asthma with bronchiectasis and 3016 patients with CS-dependent asthma without bronchiectasis. Patients with CS-dependent asthma with bronchiectasis had a higher all-cause mortality than those without bronchiectasis (8429/100,000 versus 6962/100,000 person-years, p < 0.001). The adjusted HR for mortality in patients with CS-dependent asthma with bronchiectasis relative to those without bronchiectasis was 1.33 (95% confidence interval, 1.18–1.50), and the association was primarily significant for respiratory diseases (subdistribution HR = 1.65, 95% confidence interval, 1.42–1.92). Conclusions: Bronchiectasis further increases all-cause mortality in patients with CS-dependent asthma, a trend that was especially associated with respiratory diseases including chronic obstructive pulmonary disease. Strategies to improve treatment outcomes in patients with CS-dependent asthma with bronchiectasis are urgently needed to improve long-term survival. The reviews of this paper are available via the supplemental material section.

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Intra-aortic balloon pump in acute chest pain and cardiogenic shock – a long-term follow-up

Scandinavian Cardiovascular Journal ◽

10.1080/14017431.2019.1657938 ◽

2019 ◽

Vol 53 (6) ◽

pp. 337-341

Author(s):

Bjørn Bendz ◽

Einar Gude ◽

Asgrimur Ragnarsson ◽

Knut Endresen ◽

Lars Aaberge ◽

...

Keyword(s):

Chest Pain ◽

Cardiogenic Shock ◽

Acute Chest Pain ◽

Intra Aortic Balloon Pump ◽

Long Term Follow Up

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Long-Term Risk of Death, Cardiac Events and Recurrent Chest Pain in Patients with Acute Chest Pain of Different Origin

Cardiology ◽

10.1159/000177061 ◽

1996 ◽

Vol 87 (1) ◽

pp. 60-66 ◽

Cited By ~ 50

Author(s):

Jeppe Launbjerg ◽

Per Fruergaard ◽

Birger Hesse ◽

Frank Jørgensen ◽

Lars Elsborg ◽

...

Keyword(s):

Chest Pain ◽

Acute Chest Pain ◽

Cardiac Events ◽

Risk Of Death ◽

Different Origin

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Rate of Admission and Long-Term Prognosis among Patients with Acute Chest Pain in the 1990s Compared with the 1980s

Cardiology ◽

10.1159/000086525 ◽

2005 ◽

Vol 104 (1) ◽

pp. 51-56 ◽

Cited By ~ 1

Author(s):

Johan Herlitz ◽

Björn W. Karlson ◽

Thomas Karlsson ◽

Lillemor Stensdotter ◽

Margareta Sjölin

Keyword(s):

Chest Pain ◽

Acute Chest Pain ◽

Long Term Prognosis

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Clinical Risk Stratification in the Emergency Department Predicts Long-Term Cardiovascular Outcomes in a Population-Based Cohort Presenting With Acute Chest Pain

Medicine ◽

10.1097/md.0b013e3181b98782 ◽

2009 ◽

Vol 88 (5) ◽

pp. 307-313 ◽

Cited By ~ 24

Author(s):

Michael E. Farkouh ◽

Ashish Aneja ◽

Guy S. Reeder ◽

Peter A. Smars ◽

Sameer Bansilal ◽

...

Keyword(s):

Emergency Department ◽

Chest Pain ◽

Risk Stratification ◽

Acute Chest Pain ◽

Population Based ◽

Cardiovascular Outcomes ◽

Clinical Risk

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Copeptin as a Prognostic Marker in Acute Chest Pain and Suspected Acute Coronary Syndrome

Disease Markers ◽

10.1155/2018/6597387 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

Beata Morawiec ◽

Damian Kawecki ◽

Brygida Przywara-Chowaniec ◽

Mariusz Opara ◽

Piotr Muzyk ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Chest Pain ◽

Troponin T ◽

Strong Predictor ◽

Acute Chest Pain ◽

Coronary Syndrome ◽

Cerebrovascular Events ◽

Registration Number ◽

Cox Analysis

Background. In patients admitted with chest pain and suspected acute coronary syndrome (ACS), it is crucial to early identify those who are at higher risk of adverse events. The study aim was to assess the predictive value of copeptin in patients admitted to the emergency department with chest pain and nonconclusive ECG. Methods. Consecutive patients suspected for an ACS were enrolled prospectively. Copeptin and high-sensitive troponin T (hs-TnT) were measured at admission. Patients were followed up at six and 12 months for the occurrence of death and major adverse cardiac and cerebrovascular events (MACCE). Results. Among 154 patients, 11 patients died and 26 experienced MACCE. Mortality was higher in copeptin-positive than copeptin-negative patients with no difference in the rate of MACCE. Copeptin reached the AUC 0.86 (0.75–0.97) for prognosis of mortality at six and 0.77 (0.65–0.88) at 12 months. It was higher than for hs-TnT and their combination at both time points. Copeptin was a strong predictor of mortality in the Cox analysis (HR14.1 at six and HR4.3 at 12 months). Conclusions. Copeptin appears to be an independent predictor of long-term mortality in a selected population of patients suspected for an ACS. The study registration number is ISRCTN14112941.

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Soluble Urokinase Plasminogen Activator Receptor for Risk Prediction in Patients Admitted with Acute Chest Pain

Clinical Chemistry ◽

10.1373/clinchem.2013.203778 ◽

2013 ◽

Vol 59 (11) ◽

pp. 1621-1629 ◽

Cited By ~ 29

Author(s):

Stig Lyngbæk ◽

Charlotte Andersson ◽

Jacob L Marott ◽

Daniél V Møller ◽

Michael Christiansen ◽

...

Keyword(s):

Myocardial Infarction ◽

Chest Pain ◽

Myocardial Ischemia ◽

Plasminogen Activator ◽

Urokinase Plasminogen Activator ◽

Urokinase Plasminogen Activator Receptor ◽

All Cause Mortality ◽

Plasminogen Activator Receptor ◽

Pain Patients

BACKGROUND Plasma concentrations of soluble urokinase plasminogen activator receptor (suPAR) predict mortality in several clinical settings, but the long-term prognostic importance of suPAR in chest pain patients admitted on suspicion of non–ST-segment elevation acute coronary syndrome (NSTEACS) is uncertain. METHODS suPAR concentrations were measured on admission in 449 consecutive chest pain patients in a single center between January 3, 2005, and February 14, 2006. Patients were followed for all-cause mortality from discharge until July 28, 2011. RESULTS The diagnoses at discharge comprised high-risk NSTEACS [non–ST elevation myocardial infarction or unstable angina with electrocardiogram (ECG) abnormalities] in 77 patients (17.2%) and low-risk NSTEACS without evidence of myocardial ischemia in 257 (57.2%) of patients. Another 115 (25.6%) of patients received other diagnoses. During a median follow-up of 5.7 years (range, 0.01–6.6 years) there were 162 (36.1%) deaths. suPAR was predictive of mortality independent of age, sex, smoking, final diagnosis for the hospitalization, comorbidities (diabetes, hypertension, previous myocardial infarction, and heart failure), and variables measured on the day of admission (renal function, inflammatory markers, and markers of myocardial ischemia) with a hazard ratio (95% CI) of 1.93 (1.48–2.51) per SD increase in log-transformed suPAR, P < 0.0001. The use of suPAR improved the predictive accuracy of abnormal ECG findings and increased troponin concentrations regarding all-cause mortality (c statistics, 0.751–0.805; P < 0.0001). CONCLUSIONS suPAR is a strong predictor of adverse long-term outcomes and improves risk stratification beyond traditional risk variables in chest pain patients admitted with suspected NSTEACS.

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