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Amyloid β1-40 Predicts Long-Term Mortality Rate in Patients With Acute Myocardial Infarction
Aneta Aleksova1,2, Alessandra Lucia Fluca1,2, Alessandro Pierri3
1Cardiothoracovascular Department Azienda Sanitaria Universitaria Giuliano Isontina Trieste Italy.
Insights
Amyloid β1-40 (Aβ1-40) predicts mortality in acute myocardial infarction (AMI) patients, including those with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). Higher Aβ1-40 levels indicate increased risk, aiding in patient risk stratification.
Area of Science:
- Cardiovascular Medicine
- Biomarkers
- Atherosclerosis Research
Background:
- Amyloid β1-40 (Aβ1-40) is implicated in atherosclerosis, affecting plaque stability.
- The prognostic significance of Aβ1-40 in acute myocardial infarction (AMI) is primarily studied in non-ST-segment-elevation myocardial infarction (NSTEMI).
Purpose of the Study:
- To evaluate the prognostic value of Aβ1-40 in a real-world cohort of patients with AMI (both STEMI and NSTEMI).
- To identify predictors of elevated Aβ1-40 levels in this patient population.
Main Methods:
- Analysis of 1119 consecutive AMI patients (68% STEMI).
- Measurement of serum Aβ1-40 levels on admission.
- Kaplan-Meier and Cox multivariable analyses to assess mortality risk and Aβ1-40 as a predictor.
- Development of a nomogram to predict high Aβ1-40 levels.
Main Results:
- Median Aβ1-40 was 86.9 pg/mL, with no difference between STEMI and NSTEMI.
- Predictors of higher Aβ1-40 included older age, lower ejection fraction, higher HbA1c, and lower GFR.
- Elevated Aβ1-40 levels were associated with significantly higher all-cause mortality (HR 1.03, P=0.01) in the overall cohort.
- Aβ1-40 was an independent predictor of death in STEMI patients but not in NSTEMI patients.
Conclusions:
- Aβ1-40 serves as an independent predictor of mortality in patients with acute myocardial infarction.
- Aβ1-40 measurement can enhance risk stratification strategies for AMI patients.
Background:
Amyloid β1-40 (Aβ1-40) contributes to atherosclerosis, being involved in plaque formation and destabilization. The prognostic role of Aβ1-40 in patients with acute myocardial infarction is currently limited to non-ST-segment-elevation myocardial infarction (NSTEMI). We examined the prognostic value of Aβ1-40 in a real-world cohort of patients with acute myocardial infarction (both ST-segment-elevation myocardial infarction [STEMI] and NSTEMI) and identified predictors for its elevated levels.
Methods And Results:
Our population included 1119 consecutive patients (mean age, 67 years; 72% men; and STEMI, 68%). The median Aβ1-40 concentration on admission was 86.9 (interquartile range, 54.5-128.9) pg/mL, and there was no difference in Aβ1-40 levels between NSTEMI and STEMI (P=0.1). Higher Aβ1-40 levels were predicted by older age, lower left ventricular ejection fraction, glycated hemoglobin >39 mmol/mol and glomerular filtration rate <60 mL/min per m2. From the final multivariable model, a nomogram was computed to determine probability of high Aβ1-40. During the median follow-up of 57 months, 193 patients (17.2%) died. Kaplan-Meier analysis revealed higher mortality risk in patients with Aβ1-40 levels above the median (P<0.01), consistent across STEMI (P<0.01) and NSTEMI (P=0.01) subgroups. At Cox multivariable analysis including the entire cohort, Aβ1-40 levels were predictive of death (hazard ratio, 1.03; P=0.01), together with older age, higher high-sensitivity C-reactive protein levels, smoking, glomerular filtration rate <60 mL/min per m2, worse left ventricular ejection fraction, and previous ischemic events. In the STEMI subcohort, Aβ1-40 remained a significant predictor, along with advanced age, worse left ventricular ejection fraction, smoking, and elevated high-sensitivity C-reactive protein. No such association was found in patients with NSTEMI (P=0.17), likely due to the smaller cohort size and low event rate.
Conclusions:
Aβ1-40 is an independent predictor of death and improves risk stratification in patients with acute myocardial infarction.
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