Tona Francesco, Civieri Giovanni, Vadori Marta, Masiero Giulia, Iop Laura, Perazzolo Marra Martina, Cecere Annagrazia, Martini Marika, Tansella Donatella, Bernava Giacomo, Schiavon Benedetta, Leoni Loira, Cozzi Emanuele, Iliceto Sabino
Cardiology Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
Transplant Immunology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
Front Cardiovasc Med. 2025 Aug 12;12:1515693. doi: 10.3389/fcvm.2025.1515693. eCollection 2025.
Functional autoantibodies against angiotensin II type 1 (AT1R-AAs) and endothelin-1 type A (ETAR-AAs) receptors are associated with microvascular obstruction and myocardial remodeling after ST-elevation myocardial infarction (STEMI). However, their role in the long-term prognosis after STEMI has not been investigated.
This is a prospective observational study enrolling STEMI patients undergoing early primary PCI. The incidence of major adverse cardiovascular events (MACE) was investigated during the follow-up. Autoantibody seropositivity was defined as a level >10 U/ml.
200 STEMI patients (89% male, median age 61 years) were enrolled. 110 (55%) were seronegative for both autoantibodies, 44 (22%) were seropositive for one autoantibody, and 46 (23%) were seropositive for both autoantibodies. Over a median follow-up of 1.2 years, the incidence of MACE was higher in patients with double (31%) and single (25%) seropositivity than in seronegative patients (13%, = 0.02 among groups). Double seropositivity was independently associated with higher risk of MACE (HR 2.386, 95% CI 1.471-3.864, < 0.001).
AT1R-AAs and ETAR-AAs are associated with an increased risk of MACE after STEMI. Assessment of autoantibody levels paves the way for future therapies targeting specific molecular pathways associated with poor prognosis after an acute coronary event.
抗血管紧张素II 1型受体（AT1R - AAs）和抗内皮素 - 1 A型受体（ETAR - AAs）的功能性自身抗体与ST段抬高型心肌梗死（STEMI）后的微血管阻塞和心肌重塑有关。然而，它们在STEMI后长期预后中的作用尚未得到研究。
这是一项前瞻性观察性研究，纳入接受早期直接经皮冠状动脉介入治疗（PCI）的STEMI患者。随访期间调查主要不良心血管事件（MACE）的发生率。自身抗体血清阳性定义为水平>10 U/ml。
纳入200例STEMI患者（89%为男性，中位年龄61岁）。110例（55%）两种自身抗体均为血清阴性，44例（22%）一种自身抗体血清阳性，46例（23%）两种自身抗体均血清阳性。在中位随访1.2年期间，双重血清阳性（31%）和单一血清阳性（25%）患者的MACE发生率高于血清阴性患者（13%，组间P = 0.02）。双重血清阳性与MACE风险较高独立相关（HR 2.386，95%CI 1.471 - 3.864，P < 0.001）。
AT1R - AAs和ETAR - AAs与STEMI后MACE风险增加有关。自身抗体水平的评估为未来针对急性冠状动脉事件后预后不良相关特定分子途径的治疗铺平了道路。
