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Long-term mortality in patients with ST-segment elevation myocardial infarction is associated with anti-citrullinated

Maaike P J Hermans1, Daniel van der Velden2, José M Montero Cabezas1

  • 1Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.

International Journal of Cardiology
|May 11, 2017
PubMed

Insights

Anti-citrullinated protein antibodies (ACPA) are linked to higher mortality in ST-elevation myocardial infarction (STEMI) patients without rheumatoid arthritis (RA). ACPA presence independently predicts long-term death and re-infarction in this population.

Area of Science:

  • Cardiology
  • Immunology
  • Rheumatology

Background:

  • Cardiovascular disease (CVD) mortality is elevated in rheumatoid arthritis (RA) patients, particularly those with anti-citrullinated protein antibodies (ACPA).
  • ACPA have been identified in patients with coronary artery disease (CAD) but without RA.
  • The association between ACPA and mortality in CAD patients without RA remains unclear.

Purpose of the Study:

  • To investigate the presence of ACPA in patients with ST-elevation myocardial infarction (STEMI) without RA.
  • To assess the relationship between ACPA and long-term outcomes, including mortality, in STEMI patients without RA.

Main Methods:

  • Analysis of STEMI patients from the MISSION! Intervention Study, excluding those with RA.
  • Investigation of the association between baseline ACPA (anti-CCP3) and 10-year mortality and re-infarction.

Main Results:

  • ACPA were detected in 29% (11%) of 275 STEMI patients without RA.
  • ACPA-positive patients exhibited increased cumulative cardiac mortality compared to ACPA-negative patients.
  • ACPA positivity was independently associated with long-term mortality (HR 3.1) and a combined endpoint of re-infarction and death (HR 2.4).

Conclusions:

  • In STEMI patients without RA, ACPA presence is an independent predictor of long-term mortality.
  • ACPA may function as an independent pro-atherogenic factor in both RA and non-RA patients with CAD.
  • The findings suggest ACPA as a potential biomarker for adverse cardiovascular outcomes in STEMI patients.
Abstract

Keywords:
Anti-citrullinated protein antibodiesST-segment elevation myocardial infarction

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