Plasma amino acid concentrations at admission and 28-day mortality in ST-elevation myocardial infarction

Amino acid metabolism plays a critical role in cardiovascular disease, yet its prognostic value in ST-elevation acute myocardial infarction (STEMI) remains underexplored. Therefore, we investigated whether specific plasma amino acid concentrations at admission for STEMI are associated with 28-day mortality.

This analysis was based on data from 724 patients with STEMI aged 29 to 98 years who were admitted to the University Hospital Augsburg between May 2009 and July 2013. Immediately after admission arterial blood samples were taken from these patients and a panel of amino acids was measured by a high-throughput nuclear magnetic resonance spectroscopy platform (Nightingale Health, Finland). Multivariable logistic regression models were conducted to examine the associations between the amino acids phenylalanine, tyrosine, glycine, alanine, histidine, glutamine, as well as branched-chain amino acids (BCAAs; a group that includes valine, isoleucine, and leucine) and 28-day mortality. P values were False discovery rate (FDR) adjusted.

Altogether, 47 patients died within 28 days after admission. There were significant positive associations found between plasma levels of phenylalanine, glycine, tyrosine, valine, and alanine and 28-day mortality. Phenylalanine showed the highest effect estimate (OR: 1.84; 95% CI 1.34-2.53). No significant associations were observed for the remaining amino acids.

The acute phase of STEMI is associated with changes in plasma amino acid levels that may reflect alterations in energy metabolism and metabolic stress. The associations between amino acid fluctuations and 28-day mortality highlight the potential of metabolomic profiling to refine early risk stratification.