Department of Clinical Science, University of Bergen, Bergen, Norway.
Department of Medicine, Stavanger University Hospital, Stavanger, Norway.
Thromb Haemost. 2018 Apr;118(4):778-790. doi: 10.1055/s-0038-1629912. Epub 2018 Feb 19.
Systemic fibrinogen and neopterin are related to inflammation. We investigated the prognostic utility and possible interactions of these biomarkers in stable coronary artery disease (SCAD) patients undergoing coronary angiography. We included 3,545 patients with suspected stable angina with a median follow-up of 7.3 and 10.2 years for incident acute myocardial infarction (AMI) and all-cause mortality, respectively. Prospective associations were explored by Cox regression. Potential effect modifications were investigated according to strata of fibrinogen, neopterin or high-sensitivity troponin T (hsTnT) below and above the median, as well as gender and smoking habits. During follow-up, 543 patients experienced an AMI and 769 patients died. In a multivariable model, the hazard ratios (HRs; 95% confidence interval [CI]) per 1 SD increase for fibrinogen in relation to these endpoints were 1.30 (1.20, 1.42; < 0.001) and 1.22 (1.13, 1.31; < 0.001), respectively. For neopterin, the HRs (95% CI) were 1.31 (1.23, 1.40; < 0.001) and 1.24 (1.15, 1.34; < 0.001), respectively. No significant interaction between fibrinogen and neopterin was observed. The prognostic utility of neopterin for incident AMI was improved in patients with an hsTnT above the median, for total mortality in non-smokers, and for both total mortality and AMI in females. In conclusion, both fibrinogen and neopterin were associated with future AMI and total mortality, but had low discriminatory impact. No interaction was observed between these two biomarkers. The prognostic utility of neopterin was improved in patients with hsTnT levels above the median, and in females and non-smokers.
纤维蛋白原和新蝶呤与炎症有关。我们研究了这些生物标志物在接受冠状动脉造影的稳定型冠状动脉疾病（SCAD）患者中的预后价值和可能的相互作用。我们纳入了 3545 名疑似稳定型心绞痛患者，中位随访时间分别为 7.3 年和 10.2 年，以发生急性心肌梗死（AMI）和全因死亡率为终点。通过 Cox 回归探索前瞻性关联。根据纤维蛋白原、新蝶呤或高敏肌钙蛋白 T（hsTnT）中位数以下和以上的分层，以及性别和吸烟习惯，研究了潜在的效应修饰。在随访期间，543 名患者发生 AMI，769 名患者死亡。在多变量模型中，纤维蛋白原每增加 1 个标准差与这些终点的风险比（HR）分别为 1.30（1.20，1.42；<0.001）和 1.22（1.13，1.31；<0.001）。对于新蝶呤，HR（95%CI）分别为 1.31（1.23，1.40；<0.001）和 1.24（1.15，1.34；<0.001）。未观察到纤维蛋白原和新蝶呤之间存在显著的交互作用。在 hsTnT 中位数以上的患者中，新蝶呤对 AMI 的发生有更好的预后预测作用；在不吸烟者中，新蝶呤对全因死亡率有更好的预测作用；在女性中，新蝶呤对全因死亡率和 AMI 的发生都有更好的预测作用。总之，纤维蛋白原和新蝶呤均与未来 AMI 和全因死亡率相关，但预测能力较低。未观察到这两种生物标志物之间存在相互作用。在 hsTnT 水平高于中位数的患者中，以及在女性和不吸烟者中，新蝶呤的预后预测作用得到了改善。
