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Diagnostic and prognostic value of autoantibodies anti-apolipoprotein a-1 and phosphorylcholine in suspected acute myocardial infarction

Session Poster session 4

Speaker Maria Rubini Gimenez

Event : ESC Congress 2014

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease – Pathophysiology and Mechanisms
  • Session type : Poster Session

Authors : M Rubini Gimenez (Basel,CH), R Twerenbold (Basel,CH), K Wildi (Basel,CH), T Reichlin (Basel,CH), P Haaf (Basel,CH), S Druey (Basel,CH), C Jaeger (Basel,CH), P Hillinger (Basel,CH), S Osswald (Basel,CH), C Mueller (Basel,CH)

Authors:
M. Rubini Gimenez1 , R. Twerenbold1 , K. Wildi1 , T. Reichlin1 , P. Haaf1 , S. Druey1 , C. Jaeger1 , P. Hillinger1 , S. Osswald1 , C. Mueller1 , 1University Hospital Basel, Department of Cardiology - Basel - Switzerland ,

Citation:
European Heart Journal ( 2014 ) 35 ( Abstract Supplement ), 643

Purpose: Autoantibodies have been shown to play a critical role in predicting major adverse cardiovascular events in atherosclerotic patients. We aimed to assess the diagnostic accuracy of autoantibodies to apolipoprotein A-1 (anti-apoA-1 IgG), and to phosphorylchlorine (anti-PC IgM) for non-ST segment elevation acute myocardial infarction (NSTEMI) and to explore their potential prognostic value.

Methods: This prospective multicenter study included 1072 patients presenting to the emergency department (ED) for suspected NSTEMI. The final diagnosis was adjudicated by two independent cardiologists. For both antibodies alone or expressed as a ratio (anti-apoA-1 IgG/anti-PC IgM) we determined their i) diagnostic accuracy for NSTEMI, and ii) prognostic accuracy for major adverse cardiovascular events (MACE) during 1-year follow-up.

Results: A total of 154 patients (14%) had a final diagnosis of NSTEMI. Diagnostic accuracy or the diagnosis of NSTEMI as quantified by the area under the receiver-operating characteristics curve (AUC) was very low for both autoantibodies alone or expressed as a ratio: AUC anti-apoA-1 IgG 0.50 (95%CI, 0.47-0.53, p=0.99), AUC anti-PC IgM 0.53 (95%CI, 0.50-0.56, p=0.30), and AUC of the ratio 0.52 (95%CI, 0.49-0.55, p=0.47). In contrast, hs-cTnT levels had very high diagnostic accuracy with an AUC of 0.93 (95%CI, 0.91-0.94). Adding the anti-apoA-1 IgG/Anti-PC IgM ratio to hs-cTnT did not provide incremental diagnostic value over hs-cTnT alone (Fig. 1A). MACE occurred in 221 patients (21%) during follow-up. The autoantibodies, alone or expressed as ratio, also had very low accuracy to predict MACE (p=ns) (Fig. 1B).

Conclusions: Anti-apoA-1 IgG, and anti-PC IgM autoantibodies do not seem to have diagnostic or prognostic value in patients with suspected NSTEMI.

Figure 1

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