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Published on: August 2, 2017
Prognostic value of placental growth factor in patients with acute chest pain
Christopher Heeschen1, Stefanie Dimmeler, Stephan Fichtlscherer
1Department of Cardiology, Johann Wolfgang Goethe University, Frankfurt, Germany. c.heeschen@em.uni-frankfurt.de
Insights
Placental growth factor (PlGF) in blood is a strong predictor of adverse outcomes in patients with acute coronary syndromes (ACS). Measuring PlGF levels, along with troponin T and soluble CD40 ligand, can help identify patients at very low cardiac risk.
Area of Science:
- Cardiology
- Biomarker Discovery
- Inflammation Research
Background:
- Placental growth factor (PlGF), a vascular endothelial growth factor family member, is implicated in atherosclerotic plaque instability.
- Experimental data suggest PlGF's role as an inflammatory instigator in atherosclerosis.
- PlGF may serve as a valuable risk-predicting biomarker in acute coronary syndromes (ACS).
Purpose of the Study:
- To investigate whether blood PlGF levels can predict the risk of death or nonfatal myocardial infarction in patients presenting with acute chest pain.
- To evaluate PlGF as a prognostic biomarker in the context of ACS.
Main Methods:
- PlGF levels were measured in two cohorts: 547 patients with ACS from the CAPTURE trial and 626 patients with acute chest pain.
- Other measured biomarkers included troponin T (TnT), soluble CD40 ligand (sCD40L), and high-sensitivity C-reactive protein (hsCRP).
- The primary outcome assessed was the risk of death or nonfatal myocardial infarction within 30 days.
Main Results:
- Elevated PlGF levels (>27.0 ng/L) in ACS patients significantly increased 30-day event risk (14.8% vs 4.9%).
- In multivariable analysis, elevated PlGF, TnT, and sCD40L were independent predictors of adverse events, whereas hsCRP was not.
- In patients with acute chest pain, elevated PlGF independently predicted risk (adjusted HR, 3.00).
- Patients negative for TnT, sCD40L, and PlGF exhibited very low cardiac risk.
Conclusions:
- Plasma PlGF levels are an independent biomarker for adverse outcomes in patients with suspected ACS.
- Initial plasma PlGF measurement enhances the predictive and prognostic information beyond traditional inflammatory markers.
- A combination of PlGF, TnT, and sCD40L can identify low-risk individuals effectively.
Context:
Experimental data suggest that placental growth factor (PlGF), a member of the vascular endothelial growth factor family, acts as a primary inflammatory instigator of atherosclerotic plaque instability and thus may be useful as a risk-predicting biomarker in patients with acute coronary syndromes (ACS).
Objective:
To determine whether blood levels of PlGF predict risk for death or nonfatal myocardial infarction in patients with acute chest pain.
Design, Setting, And Patients:
Measurement of PlGF levels as well as levels of markers of myocardial necrosis (troponin T [TnT]), platelet activation (soluble CD40 ligand [sCD40L]), and inflammation (high-sensitivity C-reactive protein [hsCRP]) in an inception cohort of 547 patients with angiographically validated ACS participating in the CAPTURE (c7E3 Fab Anti-Platelet Therapy in Unstable Refractory Angina) trial and in a heterogeneous cohort of 626 patients presenting with acute chest pain to an emergency department in Germany between December 1996 and March 1999.
Main Outcome Measure:
Risk for death or nonfatal myocardial infarction after 30 days.
Results:
In patients with ACS, elevated PlGF levels (>27.0 ng/L; 40.8% of patients) indicated a markedly increased risk of events at 30 days (14.8% vs 4.9%; unadjusted hazard ratio [HR], 3.34; 95% confidence interval [CI], 1.79-6.24; P<.001). In a multivariable model, elevated levels of TnT (HR, 1.83; 95% CI, 1.05-3.86; P =.03), sCD40L (HR, 2.65; 95% CI, 1.41-4.99; P =.002), and PlGF (HR, 3.03; 95% CI, 1.54-5.95; P<.001) were independent predictors, while elevated hsCRP level was not (HR, 0.98; 95% CI, 0.53-1.98; P =.94). In patients with acute chest pain, elevated levels of PlGF predicted risk (21.2% vs 5.3%) (unadjusted: HR, 4.80; 95% CI, 2.81-8.21; P<.001; adjusted: HR, 3.00; 95% CI, 1.68-5.38; P<.001). Patients negative for all 3 markers (TnT, sCD40L, and PlGF) were at very low cardiac risk (7 days: no event; 30 days: 2.1% event rate).
Conclusions:
Plasma PlGF levels may be an independent biomarker of adverse outcome in patients with suspected ACS. A single initial measurement of plasma PlGF appears to extend the predictive and prognostic information gained from traditional inflammatory markers.
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