Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Departments of Molecular Medicine and Surgery and Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
J Am Coll Cardiol. 2019 Aug 13;74(6):774-782. doi: 10.1016/j.jacc.2019.06.030.
The chemokines CCL19 and CCL21 are up-regulated in atherosclerotic disease and heart failure, and increased circulating levels are found in unstable versus stable coronary artery disease.
The purpose of this study was to evaluate the prognostic value of CCL19 and CCL21 in acute coronary syndrome (ACS).
CCL19 and CCL21 levels were analyzed in serum obtained from ACS patients (n = 1,146) on the first morning after hospital admission. Adjustments were made for GRACE (Global Registry of Acute Coronary Events) score, left ventricular ejection fraction, pro-B-type natriuretic peptide, troponin I, and C-reactive protein levels.
The major findings were: 1) those having fourth quartile levels of CCL21 on admission of ACS had a significantly higher long-term (median 98 months) risk of major adverse cardiovascular events (MACE) and myocardial infarction in fully adjusted multivariable models; 2) high CCL21 levels at admission were also independently associated with MACE and cardiovascular mortality during short-time (3 months) follow-up; and 3) high CCL19 levels at admission were associated with the development of heart failure.
CCL21 levels are independently associated with outcome after ACS and should be further investigated as a promising biomarker in these patients.
趋化因子 CCL19 和 CCL21 在动脉粥样硬化疾病和心力衰竭中上调，并且在不稳定型与稳定型冠状动脉疾病中发现循环水平升高。
本研究旨在评估 CCL19 和 CCL21 在急性冠状动脉综合征（ACS）中的预后价值。
在 ACS 患者入院后的第一个早晨，分析了血清中 CCL19 和 CCL21 的水平（n=1146）。调整了 GRACE（全球急性冠状动脉事件注册）评分、左心室射血分数、pro-B 型利钠肽、肌钙蛋白 I 和 C 反应蛋白水平。
主要发现为：1）入院时 CCL21 第四四分位数水平的患者，在完全调整的多变量模型中，具有更高的主要不良心血管事件（MACE）和心肌梗死的长期（中位数 98 个月）风险；2）入院时高 CCL21 水平也与短期（3 个月）随访期间的 MACE 和心血管死亡率独立相关；3）入院时高 CCL19 水平与心力衰竭的发展相关。
CCL21 水平与 ACS 后的预后独立相关，应作为这些患者有前途的生物标志物进一步研究。
