可溶性尿激酶型纤溶酶原激活物受体与有功能相关性的冠状动脉疾病：一项前瞻性队列研究。

Soluble urokinase plasminogen activator receptor and functionally relevant coronary artery disease: a prospective cohort study.

机构信息

Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.

Department of Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.

出版信息

Biomarkers. 2022 May;27(3):278-285. doi: 10.1080/1354750X.2022.2038269. Epub 2022 Feb 15.

DOI:10.1080/1354750X.2022.2038269

PMID:35112976

Abstract

BACKGROUND

Soluble urokinase plasminogen activator receptor (suPAR) is an emerging biomarker associated with anatomical CAD burden and cardiovascular outcomes including myocardial infarction (MI) and death. We aimed to validate previous findings of the prognostic value of suPAR and to evaluate its diagnostic potential for functional relevant CAD (fCAD).

METHODS

Consecutive patients with suspected fCAD were enrolled. Adjudication of fCAD was performed blinded to suPAR concentrations by myocardial perfusion single-photon emission tomography (MPI-SPECT) and coronary angiography. Prognostic outcome measures included all-cause death, cardiovascular death, and incident MI during 2-year follow-up.

RESULTS

Among consecutive 968 patients, suPAR concentrations were higher in patients with fCAD compared to those without (3.45 3.20 ng/mL, = 0.007), but did not provide acceptable diagnostic accuracy (area under the curve [AUC]: 0.56, 95%CI 0.52-0.60). SuPAR correlated with high-sensitivity cardiac-troponin T (Spearman's rho () 0.393, < 0.001), NT-proBNP ( = 0.327, < 0.001), age ( = 0.364, < 0.001) and very weakly with coronary atherosclerosis ( = 0.123, < 0.001). Prognostic discrimination of suPAR was moderate for cardiovascular death (AUC = 0.72, 95%CI 0.62-0.81) and all-cause death (AUC = 0.72, 95%CI 0.65-0.79) at 2-years. SuPAR remained a significant predictor for all-cause death in multivariable Cox regression (HR = 1.96, = 0.001).

CONCLUSIONS

SuPAR was an independent predictor of all-cause death, without diagnostic utility for fCAD.

CLINICAL TRIAL REGISTRATION

NCT01838148.

摘要

背景

可溶性尿激酶型纤溶酶原激活物受体（suPAR）是一种新兴的生物标志物，与解剖学 CAD 负担和心血管结局相关，包括心肌梗死（MI）和死亡。我们旨在验证 suPAR 的预后价值的先前发现，并评估其对功能性相关 CAD（fCAD）的诊断潜力。

方法

连续纳入疑似 fCAD 的患者。通过心肌灌注单光子发射断层扫描（MPI-SPECT）和冠状动脉造影对 fCAD 进行盲法裁决。预后结局指标包括 2 年随访期间的全因死亡、心血管死亡和新发 MI。

结果

在连续 968 例患者中，fCAD 患者的 suPAR 浓度高于无 fCAD 患者（3.45±3.20ng/mL， = 0.007），但未提供可接受的诊断准确性（曲线下面积 [AUC]：0.56，95%CI 0.52-0.60）。suPAR 与高敏心肌肌钙蛋白 T（Spearman's rho () 0.393， < 0.001）、NT-proBNP（ = 0.327， < 0.001）、年龄（ = 0.364， < 0.001）相关，与冠状动脉粥样硬化的相关性较弱（ = 0.123， < 0.001）。suPAR 对心血管死亡（AUC = 0.72，95%CI 0.62-0.81）和全因死亡（AUC = 0.72，95%CI 0.65-0.79）的预后区分度为中度，随访 2 年。在多变量 Cox 回归中，suPAR 仍然是全因死亡的显著预测因子（HR = 1.96， = 0.001）。