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Alkaline phosphatase and prognosis in patients with coronary artery disease
Gjin Ndrepepa1, Erion Xhepa1, Siegmund Braun2
1Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany.
Insights
Elevated alkaline phosphatase (ALP) levels in patients with coronary artery disease (CAD) are linked to a higher risk of death. This study found higher ALP activity independently predicts increased all-cause mortality within three years for CAD patients.
Area of Science:
- Cardiology
- Biomarkers
- Prognostic Factors
Background:
- Limited evidence exists on the association between alkaline phosphatase (ALP) and prognosis in coronary artery disease (CAD) patients.
- This study aimed to evaluate the link between ALP levels and the risk of mortality or adverse coronary events in CAD patients.
Purpose of the Study:
- To assess the association of alkaline phosphatase (ALP) with the risk of all-cause mortality and coronary events in patients with coronary artery disease (CAD).
Main Methods:
- The study included 5540 patients with angiography-proven CAD who underwent catheter-based coronary revascularization.
- Patients were categorized into three groups based on baseline ALP tertiles (≤ 65.5 U/L, 65.5-85.7 U/L, > 85.7 U/L).
- The primary outcome was all-cause mortality assessed at a 3-year follow-up.
Main Results:
- A total of 443 deaths were recorded across the study population.
- Patients in the highest ALP tertile (> 85.7 U/L) had significantly higher unadjusted and adjusted risks of all-cause mortality compared to the lowest tertile.
- Inclusion of ALP levels improved the predictive model for all-cause mortality (delta C statistic = 0.005, P < 0.001).
Conclusions:
- Elevated alkaline phosphatase (ALP) activity is independently associated with an increased risk of 3-year all-cause mortality in patients with coronary artery disease (CAD).
- ALP may serve as a valuable prognostic biomarker in CAD management.
Background:
The evidence on the association between alkaline phosphatase (ALP) and prognosis of patients with coronary artery disease (CAD) is limited. The aim of this study was to assess the association of ALP with the risk of mortality or coronary events in patients with CAD.
Materials And Methods:
The study included 5540 patients with angiography-proven CAD treated with catheter-based coronary revascularization. Baseline ALP measurements were available for analysis in all patients. Patients were divided into three groups: a group with an ALP activity in the 1st tertile (ALP ≤ 65·5 U/L; n = 1855), a group with an ALP activity in the 2nd tertile (ALP > 65·5 to 85·7 U/L; n = 1839) and a group with an ALP in the 3rd tertile (ALP > 85·7 U/L; n = 1846). The primary outcome was all-cause mortality at 3-year follow-up.
Results:
All-cause deaths (number [Kaplan-Meier estimates]) occurred in 443 patients: 117 (7·2%), 130 (8·1%) and 196 deaths (11·8%) among patients of the 1st, 2nd and 3rd ALP tertiles (unadjusted hazard ratio [HR] = 1·33, 95% confidence interval [CI]: 1·19 to 1·50; P < 0·001, calculated per tertile increment in the ALP activity). After adjustment in multivariable Cox proportional hazards model, ALP was independently associated with the risk of all-cause mortality (adjusted HR = 1·33 [1·18-1·51], P < 0·001, calculated per unit increment in log ALP). The multivariable model for all-cause mortality with baseline variables without ALP had a C statistic of 0·820 [0·797-0·843] which increased to 0·825 [0·804-0·849] after ALP inclusion; delta C statistic 0·005 [0·001-0·011]; P < 0·001.
Conclusions:
In patients with CAD, elevated ALP activity was independently associated with the risk of 3-year all-cause mortality.