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Risk stratification in unstable angina and non-Q wave myocardial infarction using soluble cell adhesion molecules
N T Mulvihill1, J B Foley, R T Murphy
1Royal City of Dublin Hospital Research and Education Institute, Department of Cardiology, St James's Hospital, Dublin 8, Ireland. mulvihin@hotmail.com
Insights
Soluble vascular cell adhesion molecule-1 (sVCAM-1) and C-reactive protein (CRP) predict major adverse cardiovascular events in patients with unstable angina. These biomarkers indicate the severity of vascular inflammation and clinical outcomes.
Area of Science:
- Cardiology
- Biomarkers
- Inflammation
Background:
- Unstable angina and non-Q wave myocardial infarction are critical conditions requiring accurate prognostic markers.
- Cellular adhesion molecules (CAMs) and C-reactive protein (CRP) are implicated in the inflammatory processes underlying these conditions.
Purpose of the Study:
- To prospectively evaluate the prognostic value of soluble CAMs and CRP in patients with unstable angina and non-Q wave myocardial infarction.
- To compare the predictive accuracy of soluble CAMs with CRP for major adverse cardiovascular events.
Main Methods:
- A prospective observational study included 91 patients with unstable angina or non-Q wave myocardial infarction.
- Serum concentrations of soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), and CRP were measured at presentation.
- Patients were followed for six months for major adverse cardiovascular events.
Main Results:
- Major adverse cardiovascular events occurred in 30% of patients within six months.
- Significantly elevated concentrations of CRP and sVCAM-1 were observed in patients experiencing ischemic events.
- Both sVCAM-1 and CRP demonstrated high sensitivity (>90%) in predicting future adverse events.
Conclusions:
- Elevated sVCAM-1 and CRP levels are significant predictors of increased risk for major adverse cardiovascular events.
- These findings highlight the role of vascular inflammation intensity at presentation in determining clinical outcomes.
- sVCAM-1 and CRP serve as valuable prognostic biomarkers in unstable coronary artery disease.
Objective:
To assess prospectively the prognostic value of soluble cellular adhesion molecules (CAMs) in patients with unstable angina and non-Q wave myocardial infarction and to compare their prognostic accuracy with that of C reactive protein (CRP).
Design And Setting:
Prospective observational study of patients presenting acutely with unstable angina and non-Q wave myocardial infarction to a single south Dublin hospital.
Methods:
Patients with Braunwald IIIA unstable angina and non-Q wave myocardial infarction had serum samples taken at presentation before initiation of antithrombotic treatment and were followed for six months. The primary end point was the occurrence of major adverse cardiovascular events (recurrent unstable angina, non-fatal myocardial infarction, and cardiovascular death) at six months. Concentrations of soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble endothelial selectin, and soluble platelet selectin were measured using an enzyme linked immunosorbent assay technique. CRP was measured with an immunophelometric assay.
Results:
91 patients (73 men and 18 women, mean (SD) age 61 (11) years) were studied; 27 patients (30%) had major adverse cardiac events during the six months of follow up. Concentration of CRP were significantly raised in patients who had an ischaemic event (mean (SEM) 11.5 (6.4) mg/l v 5.4 (2.5) mg/l, p < 0.001). Concentrations of sVCAM-1 were also significantly raised in the ischaemic event group (979 (30) ng/ml v 729 (22) ng/ml, p < 0.001). Both sVCAM-1 and CRP concentrations correlated strongly with the occurrence of an adverse event. The sensitivity of CRP > 3 mg/l and sVCAM-1 > 780 ng/ml for predicting future events was > 90%. There was no difference in concentrations of sICAM-1, soluble endothelin selectin, or soluble platelet selectin between event and non-event groups.
Conclusion:
Raised concentrations of sVCAM-1 and CRP are predictive of an increased risk of major adverse cardiovascular events six months after presentation with unstable angina and non-Q wave myocardial infarction. These findings suggest that the intensity of the vascular inflammatory process at the time of presentation is a determinant of clinical outcome in unstable coronary artery disease.