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Published on: May 28, 2019
Prognostic Value of Serum Antiphospholipid Antibodies in Patients with ST-Segment Elevation Myocardial Infarction
Mohamed M Amin1, Ayman M Ibrahim2, Ehab M Fahmy1
1Department of Microbiology & Immunology, Faculty of Medicine, Aswan University, Aswan, Egypt.
Insights
Antiphospholipid syndrome (APS) patients with Acute Myocardial Infarction (AMI) have varying antibody levels. Anticardiolipin IgG shows protective effects, while anticardiolipin IgM and antiphosphatidyl inositol IgM indicate higher complication risks.
Area of Science:
- Cardiology
- Immunology
- Thrombosis
Background:
- Primary Antiphospholipid syndrome (APS) is linked to hypercoagulability, increasing risks of thromboembolic events and coronary restenosis.
- Acute Myocardial Infarction (AMI) is a rare but serious complication of APS, occurring in approximately 4% of cases.
- Managing APS patients presents clinical challenges due to their predisposition to thrombotic events.
Purpose of the Study:
- To investigate the correlation between antiphospholipid antibodies (aPL) and complication-associated AMI in Aswan governorate.
- To assess the predictive value of specific aPLs for cardiovascular event recurrence in AMI patients.
- To understand the distinct roles of various aPLs in the pathogenesis of AMI within the APS context.
Main Methods:
- A case-control study comparing 50 AMI patients with 30 healthy controls.
- Serum aPL levels, including Lupus anticoagulant, IgM and IgG anticardiolipin (aCA), and antiphosphatidyl inositol (aPI), were measured using ELISA kits.
- Patients were followed up to assess the correlation between aPL levels and subsequent cardiovascular complications.
Main Results:
- Mean Lupus anticoagulant levels were 59.2 U/mL, IgM anticardiolipin (aCA IgM) at 1.14 U/mL, IgG anticardiolipin (aCA IgG) at 1.26 U/mL, and antiphosphatidyl inositol (aPI) at 11.68 U/mL in AMI patients.
- aCA IgG demonstrated a protective effect against complications (P=0.001, r=-0.463).
- aPI-IgM showed a moderate correlation with complications (P=0.048, r=0.281), while Lupus anticoagulant and aCA IgM had weak correlations.
Conclusions:
- Anticardiolipin antibodies (aCAs) play distinct roles in AMI pathogenesis; reduced aCA IgG levels are protective, whereas aCA IgM indicates a poor prognosis.
- Antiphosphatidyl inositol (aPI) serves as a valuable marker for predicting the recurrence of cardiovascular events in APS patients.
- Understanding these specific antibody profiles can aid in risk stratification and management of APS patients with AMI.
Abstract:
Hypercoagulability in patients with primary Antiphospholipid syndrome (APS) predisposes to high rates of thromboembolic events and restenosis of the coronaries causing significant morbidity and mortality. Although the association between the APS and Acute Myocardial infraction (AMI) is very rare about 4%. Treatment of patients with APS represent a clinical challenge. Current study was designed to investigate the correlation between antiphospholipid antibodies (aPL) in prediction of the complication-associated AMI in Aswan governorate. Fifty AMI patients were compared to thirty controls. Serum aPLs was assessed using commercial ELISA kits. In patients; data revealed that mean Lupus anticoagulant was 59.2 U/mL, IgM and IgG anticardiolipin was 1.14 U/mL and 1.26 U/mL respectively. In addition the mean of antiphosphatidyl inositol (aPI) was 11.68 U/mL. On follow-up; Lupus and aCA IgM showed weak correlation with cases that showed further complications, while aCA-IgG showed protective effects (P=0.001/ r=-0.463) and aPI-IgM moderate correlation with the complications (P=0.048/ r=0.281). It's concluded that aCAs play distinct roles in the pathogenesis of AMI reduced levels of aCA-IgG has protective effects while the aCA-IgM indicate a poor prognosis, and that aPI is a good marker for prediction of recurrence of cardiovascular events among patients.
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