Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals, 4 rue Gabrielle Perret-Gentil, 1211 Geneva, Switzerland.
Thromb Haemost. 2013 Apr;109(4):706-15. doi: 10.1160/TH12-10-0714. Epub 2013 Jan 31.
We aimed at challenging the prognostic accuracies of myeloperoxidase (MPO) and antibodies anti-apolipoprotein A-1 (anti-apoA-1 IgG), alone or in combination, for major adverse cardiovascular events (MACE) prediction, one year after carotid endarterectomy (CEA). In this prospective single centre study, 178 patients undergoing elective CEA were included. Serum anti-apoA-1 IgG and MPO were assessed by enzyme-linked immunosorbent assay prior to the surgery. Post-hoc determination of the MPO cut-off was performed by receiver operating characteristics (ROC) analyses. MACE was defined by the occurrence of fatal or non-fatal acute coronary syndromes or stroke during one year follow-up. Prognostic accuracy of anti-apoA-1 IgG was assessed by ROC curve analyses, survival analyses and reclassification statistics. During follow-up, 5% (9/178) of patients presented a MACE, and 29% (52/178) were positive for anti-apoA-1 IgG. Patients with MACE had higher median MPO and anti-apoA-1 IgG levels at admission (p=0.01), but no difference for the 10-year global Framingham risk score (FRS) was observed (p=0.22). ROC analyses indicated that both MPO and anti-apoA-1 IgG were significant predictors of subsequent MACE (area under the curve [AUC]: 0.75, 95% confidence interval [95%CI]: 0.61-0.89, p=0.01; and 0.74, 95%CI: 0.59-90; p=0.01), but combining anti-apoA-1 IgG positivity and MPO>857 ng/ml displayed the best predictive accuracy (AUC: 0.78, 95%CI: 0.65-0.91; p=0.007). It was associated with a poorer MACE-free survival (98.2% vs. 57.1%; p<0.001, LogRank), with a positive likelihood ratio of 13.67, and provided incremental predictive ability over FRS. In conclusion, combining the assessment of anti-apoA-1 IgG and MPO appears as a promising risk stratification tool in patients with severe carotid stenosis.
我们旨在挑战髓过氧化物酶（MPO）和抗载脂蛋白 A-1 抗体（抗 apoA-1 IgG）单独或联合用于预测颈动脉内膜切除术（CEA）后 1 年内主要不良心血管事件（MACE）的预后准确性。在这项前瞻性单中心研究中，纳入了 178 名接受择期 CEA 的患者。手术前通过酶联免疫吸附试验评估血清抗 apoA-1 IgG 和 MPO。通过接收者操作特征（ROC）分析进行 MPO 截断值的事后确定。MACE 的定义是在 1 年随访期间发生致命或非致命性急性冠状动脉综合征或中风。通过 ROC 曲线分析、生存分析和重新分类统计评估抗 apoA-1 IgG 的预后准确性。在随访期间，5%（9/178）的患者发生 MACE，29%（52/178）的患者抗 apoA-1 IgG 阳性。发生 MACE 的患者入院时的 MPO 和抗 apoA-1 IgG 中位数水平较高（p=0.01），但 10 年全球弗雷明汉风险评分（FRS）无差异（p=0.22）。ROC 分析表明，MPO 和抗 apoA-1 IgG 均是随后发生 MACE 的显著预测因子（曲线下面积[ AUC ]：0.75，95%置信区间[95%CI]：0.61-0.89，p=0.01；和 0.74，95%CI：0.59-90；p=0.01），但将抗 apoA-1 IgG 阳性和 MPO＞857 ng/ml 相结合显示出最佳的预测准确性（AUC：0.78，95%CI：0.65-0.91；p=0.007）。它与无 MACE 生存率较差相关（98.2%与 57.1%；p＜0.001，LogRank），阳性似然比为 13.67，并提供了比 FRS 更高的预测能力。总之，联合评估抗 apoA-1 IgG 和 MPO 似乎是严重颈动脉狭窄患者有希望的风险分层工具。
