Rubini Gimenez Maria, Pagano Sabrina, Virzi Julien, Montecucco Fabrizio, Twerenbold Raphael, Reichlin Tobias, Wildi Karin, Grueter Daniel, Jaeger Cedric, Haaf Philip, Vuilleumier Nicolas, Mueller Christian
Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Eur J Clin Invest. 2015 Apr;45(4):369-79. doi: 10.1111/eci.12411. Epub 2015 Mar 9.
Autoantibodies have been shown to play a critical role in predicting major adverse cardiovascular events in atherosclerotic patients. We aimed to assess the diagnostic accuracy of autoantibodies to apolipoprotein A-1 (anti-apoA-1 IgG) and to phosphorylcholine (anti-PC IgM) for non-ST segment elevation acute myocardial infarction (NSTEMI) and to explore their potential prognostic value.
This prospective multicentre study included 1072 patients presenting to the emergency department for suspected NSTEMI. The final diagnosis was adjudicated by two independent cardiologists. For both antibodies alone or expressed as a ratio (anti-apoA-1 IgG/anti-PC IgM), we determined their (i) diagnostic accuracy for NSTEMI and (ii) prognostic accuracy for major adverse cardiovascular events (MACE) during 1-year follow-up.
A total of 154 patients (14%) had a final diagnosis of NSTEMI. Diagnostic accuracy for the diagnosis of NSTEMI as quantified by the area under the receiver operating characteristics curve (AUC) was very low for both autoantibodies separately as well as combined as a ratio: AUC anti-apoA-1 IgG 0.50 (95%CI, 0.47-0.53, P = 0.99), AUC anti-PC IgM 0.53 (95%CI, 0.50-0.56, P = 0.30) and AUC of the ratio 0.52 (95%CI, 0.49-0.55, P = 0.47). Adding the anti-apoA-1 IgG/Anti-PC IgM ratio to hs-cTnT did not provide incremental diagnostic value over hs-cTnT alone. MACE occurred in 221 patients (21%) during follow-up. The autoantibodies, separately or expressed as ratio, also had very low accuracy to predict MACE (p=ns).
Anti-apoA-1 IgG and anti-PC IgM autoantibodies did not have diagnostic or prognostic value in patients with NSTEMI.
自身抗体已被证明在预测动脉粥样硬化患者的主要不良心血管事件中起关键作用。我们旨在评估抗载脂蛋白A-1自身抗体（抗载脂蛋白A-1 IgG）和抗磷酸胆碱自身抗体（抗PC IgM）对非ST段抬高型急性心肌梗死（NSTEMI）的诊断准确性，并探讨其潜在的预后价值。
这项前瞻性多中心研究纳入了1072名因疑似NSTEMI而到急诊科就诊的患者。最终诊断由两名独立的心脏病专家判定。对于单独的两种抗体或表示为比值（抗载脂蛋白A-1 IgG/抗PC IgM），我们确定了它们（i）对NSTEMI的诊断准确性以及（ii）在1年随访期间对主要不良心血管事件（MACE）的预后准确性。
共有154名患者（14%）最终诊断为NSTEMI。通过受试者工作特征曲线下面积（AUC）量化的NSTEMI诊断准确性，无论是单独的两种自身抗体还是作为比值组合，都非常低：抗载脂蛋白A-1 IgG的AUC为0.50（95%CI，0.47-0.53，P = 0.99），抗PC IgM的AUC为0.53（95%CI，0.50-0.56，P = 0.30），比值的AUC为0.52（95%CI，0.49-0.55，P = 0.47）。将抗载脂蛋白A-1 IgG/抗PC IgM比值添加到高敏肌钙蛋白T（hs-cTnT）中，并没有比单独的hs-cTnT提供更高的诊断价值。随访期间有221名患者（21%）发生了MACE。这些自身抗体，单独或表示为比值，预测MACE的准确性也非常低（p=无显著性差异）。
抗载脂蛋白A-1 IgG和抗PC IgM自身抗体在NSTEMI患者中没有诊断或预后价值。
