Related Experiment Video
Updated: Jun 27, 2026
Digital PCR for Quantifying Circulating MicroRNAs in Acute Myocardial Infarction and Cardiovascular Disease
Published on: July 3, 2018
Decreased activated protein C levels as a clinical predictor in patients with ST-elevation myocardial infarction
Nobutaka Chiba1, Ken Nagao, Takeo Mukoyama
1Department of Emergency and Critical Care Medicine, Nihon University School of Medicine, and Surugadai Nihon University Hospital, Tokyo, Japan. nobuc@med.nihon-u.ac.jp
Insights
Activated protein C (APC) levels predict mortality in ST-elevation myocardial infarction (STEMI) patients. Lower APC levels are associated with increased risk of inhospital death, aiding risk stratification.
Area of Science:
- Cardiology
- Biochemistry
Background:
- Atherosclerotic plaque instability markers are crucial for acute coronary syndromes.
- Activated protein C (APC) possesses antithrombotic, anti-inflammatory, and profibrinolytic properties.
- APC's potential as a clinical predictor in ST-elevation myocardial infarction (STEMI) and cardiac arrest recovery is explored.
Purpose of the Study:
- To evaluate activated protein C (APC) as a predictor of inhospital death in STEMI patients.
- To assess the prognostic value of APC levels in patients experiencing sudden cardiac arrest with STEMI.
Main Methods:
- 335 STEMI patients had their APC levels measured upon emergency room arrival.
- The primary endpoint was inhospital mortality from any cause.
Main Results:
- Inhospital death rates increased with decreasing APC levels (P<.001).
- This association remained significant in STEMI-only and cardiac arrest subgroups.
- An APC cutoff of 65% demonstrated optimal sensitivity and specificity for predicting death, with an odds ratio of 9.4 for the lowest quartile.
Conclusions:
- APC levels offer valuable predictive information for risk stratification in STEMI patients.
- Low APC levels may indicate a higher risk of mortality post-STEMI.
Background:
Circulating markers that indicate atherosclerotic plaque instability may have diagnostic and prognostic value in patients with acute coronary syndromes. We evaluated activated protein C (APC), which has antithrombotic, anti-inflammatory, and profibrinolytic properties, as a possible clinical predictor in ST-elevation myocardial infarction (STEMI), including return of spontaneous circulation after sudden cardiac arrest.
Methods:
Patients with STEMI whose APC level was measured upon arrival at the emergency room were enrolled in this study (n=335). The primary end point was inhospital death from any cause.
Results:
The APC level ranged from 29% to 142% with a median of 80%. The unadjusted death rate increased in a stepwise fashion with decreasing APC levels (33.7% in quartile 1, 12.7% in 2, 6.0% in 3, and 3.6% in 4, P<.001). This association remained significant in subgroups of patients with STEMI only (P=.04) or with return of spontaneous circulation (P=.01). After adjusting for independent predictors of inhospital death, the odds ratio for death among those in the first quartile of APC levels was 9.4 (95% CI 1.1-81.6, P=.04). A cutoff APC level of 65% had the highest combined sensitivity and specificity in predicting death.
Conclusions:
Measuring APC levels provides predictive information for use in risk stratification across the STEMI spectrum. Decreased APC levels may be a unifying feature among patients at high risk for death after STEMI.
Related Concept Videos
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:30Acute Coronary Syndrome I: Introduction
01:27Myocarditis II: Clinical Features and Diagnostic Tests