Elevated placental growth factor levels are associated with adverse outcomes at four-year follow-up in patients with acute coronary syndromes
Elevated placental growth factor levels are associated with adverse outcomes at four-year follow-up in patients with acute coronary syndromes
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DOI：
10.1016/j.jacc.2005.08.063
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发表时间：
2006-01-17
影响因子：
24
通讯作者：
Boersma, E
中科院分区：
文献类型：
--
作者：
Lenderink, T;Heeschen, C;Boersma, E
本研究旨在评估基线胎盘生长因子（PIGF）综合征（ACS）的预测价值。作为一种血管炎症的生物标志物，PlGF被认为是ACS患者短期预后的有力预测因子。方法在544例入选不稳定难治性心绞痛c7 E3 Fab抗血小板治疗（CAPTURE）试验的安慰剂组的患者中，测定PlGF水平以及心肌坏死的标志物，（肌钙蛋白T [TnT]）、全身炎症（高敏C反应蛋白[hsCRP]）和血小板活化（可溶性CD 40配体[sCD 40 L]）。应用考克斯比例风险回归分析来评估生物标志物与全因死亡或非致命性心肌梗死发生率之间的关系，随访时间中位数为4年。（>27纳克/升）的死亡率高于水平较低的（10.8% vs. 3.2%;风险比[HR]，3.3; 95%可信区间[CI]，1.6 - 7.1），以及死亡或心肌梗死复合终点的发生率较高（27.6% vs. 11.3%事件; HR，2.6; 95% CI，1.7 - 3.9）。调整TnT、sCD 40 L和hsCRP后，PlGF和复合终点之间的关系仍然显著（调整后HR为3.3; 95%CI为2.0 - 5.4）。结论：在ACS患者中，PlGF血浆水平升高与长期随访期间不良心脏结局相关。这些数据表明，PlGF作为一个更具体的血管炎症标记物，应考虑ACS患者的危险分层，而不是一般的炎症标记物。
OBJECTIVES This study sought to evaluate the predictive value of baseline placental growth factor (PIGF) syndromes (ACS). for long-term cardiovascular events in acute coronary 11BACKGROUND A biomarker of vascular inflammation, PlGF is identified as a powerful predictor for short-term outcome in patients with ACS.METHODS In 544 patients who were enrolled in the placebo arm of the c7E3 Fab Anti Platelet Therapy in Unstable REfractory angina (CAPTURE) trial, PlGF levels were determined as well as markers of myocardial necrosis (troponin T [TnT]), general inflammation (high-sensitivity C-reactive protein [hsCRP]), and platelet activation (soluble CD40 ligand [sCD40L]). Cox proportional hazard regression analyses were applied to evaluate the relationship between biomarkers and the occurrence of all-cause death or non-fatal myocardial infarction during a median follow-up period of four years.RESULTS Patients with PIGF levels in the fourth and fifth quintile (>27 ng/l) had higher mortality than those with lower levels (10.8% vs. 3.2%; hazard ratio [HR], 3.3; 95% confidence interval [CI], 1.6 to 7.1), as well as a higher incidence of the composite end point of death or myocardial infarction (27.6% vs. 11.3% events; HR, 2.6; 95% CI, 1.7 to 3.9). The relationship between PIGF and the composite end point remained significant after adjustment for TnT, sCD40L, and hsCRP (adjusted HR, 3.3; 95% CI, 2.0 to 5.4).CONCLUSIONS In patients with ACS, elevated plasma levels of PlGF are associated with adverse cardiac outcomes during long-term follow-up. These data suggest that PlGF as a more specific marker of vascular inflammation should be considered for risk stratification of patients with ACS rather than general markers of inflammation.