淀粉样蛋白β1-40可预测急性心肌梗死患者的长期死亡率。
Amyloid β1-40 Predicts Long-Term Mortality Rate in Patients With Acute Myocardial Infarction.
作者信息
Aleksova Aneta, Fluca Alessandra Lucia, Pierri Alessandro, Barbati Giulia, Beltrami Antonio Paolo, Padoan Laura, Merro Enzo, Marketou Maria, Zwas Donna, D'Errico Stefano, Sinagra Gianfranco, Janjusevic Milijana
机构信息
Cardiothoracovascular Department Azienda Sanitaria Universitaria Giuliano Isontina Trieste Italy.
Department of Medical Surgical and Health Sciences University of Trieste Italy.
出版信息
J Am Heart Assoc. 2025 Apr 15;14(8):e035620. doi: 10.1161/JAHA.124.035620. Epub 2025 Apr 3.
BACKGROUND
Amyloid β1-40 (Aβ1-40) contributes to atherosclerosis, being involved in plaque formation and destabilization. The prognostic role of Aβ1-40 in patients with acute myocardial infarction is currently limited to non-ST-segment-elevation myocardial infarction (NSTEMI). We examined the prognostic value of Aβ1-40 in a real-world cohort of patients with acute myocardial infarction (both ST-segment-elevation myocardial infarction [STEMI] and NSTEMI) and identified predictors for its elevated levels.
METHODS AND RESULTS
Our population included 1119 consecutive patients (mean age, 67 years; 72% men; and STEMI, 68%). The median Aβ1-40 concentration on admission was 86.9 (interquartile range, 54.5-128.9) pg/mL, and there was no difference in Aβ1-40 levels between NSTEMI and STEMI (=0.1). Higher Aβ1-40 levels were predicted by older age, lower left ventricular ejection fraction, glycated hemoglobin >39 mmol/mol and glomerular filtration rate <60 mL/min per m. From the final multivariable model, a nomogram was computed to determine probability of high Aβ1-40. During the median follow-up of 57 months, 193 patients (17.2%) died. Kaplan-Meier analysis revealed higher mortality risk in patients with Aβ1-40 levels above the median (<0.01), consistent across STEMI (<0.01) and NSTEMI (=0.01) subgroups. At Cox multivariable analysis including the entire cohort, Aβ1-40 levels were predictive of death (hazard ratio, 1.03; =0.01), together with older age, higher high-sensitivity C-reactive protein levels, smoking, glomerular filtration rate <60 mL/min per m, worse left ventricular ejection fraction, and previous ischemic events. In the STEMI subcohort, Aβ1-40 remained a significant predictor, along with advanced age, worse left ventricular ejection fraction, smoking, and elevated high-sensitivity C-reactive protein. No such association was found in patients with NSTEMI (=0.17), likely due to the smaller cohort size and low event rate.
CONCLUSIONS
Aβ1-40 is an independent predictor of death and improves risk stratification in patients with acute myocardial infarction.
背景
淀粉样β1-40（Aβ1-40）参与动脉粥样硬化的发生发展，与斑块形成和斑块不稳定有关。目前，Aβ1-40在急性心肌梗死患者中的预后价值仅限于非ST段抬高型心肌梗死（NSTEMI）。我们研究了Aβ1-40在急性心肌梗死（ST段抬高型心肌梗死[STEMI]和NSTEMI）真实世界队列中的预后价值，并确定了其水平升高的预测因素。
方法和结果
我们的研究人群包括1119例连续入选的患者（平均年龄67岁；男性占72%；STEMI患者占68%）。入院时Aβ1-40浓度的中位数为86.9（四分位间距为54.5-128.9）pg/mL，NSTEMI和STEMI患者的Aβ1-40水平无差异（P=0.1）。年龄较大、左心室射血分数较低、糖化血红蛋白>39 mmol/mol和肾小球滤过率<60 mL/min per m可预测Aβ1-40水平较高。根据最终的多变量模型，计算出列线图以确定Aβ1-40水平升高的概率。在中位随访57个月期间，193例患者（17.2%）死亡。Kaplan-Meier分析显示，Aβ1-40水平高于中位数的患者死亡风险较高（P<0.01），在STEMI（P<0.01）和NSTEMI（P=0.01）亚组中均一致。在包括整个队列的Cox多变量分析中，Aβ1-40水平可预测死亡（风险比为1.03；P=0.01），此外还有年龄较大、高敏C反应蛋白水平较高、吸烟、肾小球滤过率< 60 mL/min per m、左心室射血分数较差以及既往缺血事件。在STEMI亚组中，Aβ1-40仍然是一个显著的预测因素，此外还有高龄、左心室射血分数较差、吸烟和高敏C反应蛋白升高。在NSTEMI患者中未发现此类关联（P=0.17），可能是由于队列规模较小和事件发生率较低。
结论
Aβ1-40是急性心肌梗死患者死亡的独立预测因素，可改善风险分层。
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