Vuilleumier Nicolas, Pagano Sabrina, Combescure Christophe, Gencer Baris, Virzi Julien, Räber Lorenz, Carballo David, Carballo Sebastian, Nanchen David, Rodondi Nicolas, Windecker Stephan, Hazen Stanley L, Wang Zeneng, Li Xinmin S, von Eckardstein Arnold, Matter Christian M, Lüscher Thomas F, Klingenberg Roland, Mach Francois
Division of Laboratory Medicine, Diagnostic Department, Geneva University Hospital, 1205 Geneva, Switzerland.
Department of Internal Medicine specialities, Medical Faculty, Geneva University, 1205 Geneva, Switzerland.
J Clin Med. 2019 Jul 9;8(7):1002. doi: 10.3390/jcm8071002.
Autoantibodies against apolipoprotein A-I (anti-apoA-I IgGs) are prevalent in atherosclerosis-related conditions. It remains elusive whether they improve the prognostic accuracy of the Global Registry of Acute Coronary Events (GRACE) score 2.0 (GS) in acute coronary syndromes (ACS). In this prospective multicenter registry, 1713 ACS patients were included and followed for 1 year. The primary endpoint (major adverse cardiovascular events (MACE)) was defined as the composite of myocardial infarction, stroke (including transient ischemic attack), or cardiovascular (CV) death with individual events independently adjudicated. Plasma levels of anti-apoA-I IgGs upon study inclusion were assessed using ELISA. The association between anti-apoA-I IgGs and incident MACE was assessed using Cox models with splines and C-statistics. One-year MACE incidence was 8.4% (144/1713). Anti-apoA-I IgG levels were associated with MACE with a non-linear relationship ( = 0.01), which remained unchanged after adjusting for the GS ( = 0.04). The hazard increased progressively across the two first anti-apoA-I IgG quartiles before decreasing thereafter. Anti-apoA-I IgGs marginally improved the prognostic accuracy of the GS (c-statistics increased from 0.68 to 0.70). In this multicenter study, anti-apoA-I IgGs were predictive of incident MACE in ACS independently of the GS but in a nonlinear manner. The practical implications of these findings remain to be defined.
抗载脂蛋白A-I自身抗体（抗载脂蛋白A-I IgG）在动脉粥样硬化相关疾病中普遍存在。在急性冠状动脉综合征（ACS）中，它们是否能提高全球急性冠状动脉事件注册研究（GRACE）评分2.0（GS）的预后准确性仍不清楚。在这项前瞻性多中心注册研究中，纳入了1713例ACS患者并随访1年。主要终点（主要不良心血管事件（MACE））定义为心肌梗死、中风（包括短暂性脑缺血发作）或心血管（CV）死亡的复合事件，各事件由独立判定。研究纳入时使用酶联免疫吸附测定法评估血浆抗载脂蛋白A-I IgG水平。使用带样条的Cox模型和C统计量评估抗载脂蛋白A-I IgG与新发MACE之间的关联。1年MACE发生率为8.4%（144/1713）。抗载脂蛋白A-I IgG水平与MACE呈非线性关系（P = 0.01），在调整GS后仍保持不变（P = 0.04）。在前两个抗载脂蛋白A-I IgG四分位数中，风险逐渐增加，此后降低。抗载脂蛋白A-I IgG略微提高了GS的预后准确性（C统计量从0.68提高到0.70）。在这项多中心研究中，抗载脂蛋白A-I IgG可独立于GS预测ACS患者的新发MACE，但呈非线性方式。这些发现的实际意义仍有待确定。
