Amyloid β1-40 Predicts Long-Term Mortality Rate in Patients With Acute Myocardial Infarction.

IF 5 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Heart Association Pub Date : 2025-04-03 DOI:10.1161/JAHA.124.035620

Aneta Aleksova, Alessandra Lucia Fluca, Alessandro Pierri, Giulia Barbati, Antonio Paolo Beltrami, Laura Padoan, Enzo Merro, Maria Marketou, Donna Zwas, Stefano D'Errico, Gianfranco Sinagra, Milijana Janjusevic

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引用次数: 0

Abstract

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 (P=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 m². 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 (P<0.01), consistent across STEMI (P<0.01) and NSTEMI (P=0.01) subgroups. At Cox multivariable analysis including the entire cohort, Aβ1-40 levels were predictive of death (hazard ratio, 1.03; P=0.01), together with older age, higher high-sensitivity C-reactive protein levels, smoking, glomerular filtration rate <60 mL/min per m², 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 (P=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.

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淀粉样蛋白β1-40预测急性心肌梗死患者的长期死亡率。

背景：淀粉样蛋白β1-40（Aβ1-40）参与斑块的形成和稳定，是动脉粥样硬化的诱因之一。目前，Aβ1-40 在急性心肌梗死患者中的预后作用仅限于非 ST 段抬高型心肌梗死（NSTEMI）。我们研究了急性心肌梗死（ST 段抬高型心肌梗死 [STEMI] 和 NSTEMI）患者队列中 Aβ1-40 的预后价值，并确定了其水平升高的预测因素：我们的研究对象包括 1119 名连续患者（平均年龄 67 岁；72% 为男性；68% 为 STEMI）。入院时 Aβ1-40 浓度的中位数为 86.9（四分位距为 54.5-128.9）pg/mL，NSTEMI 和 STEMI 之间的 Aβ1-40 水平没有差异（P=0.1）。年龄越大、左心室射血分数越低、糖化血红蛋白>39 mmol/mol和肾小球滤过率2可预测Aβ1-40水平越高。根据最终的多变量模型，计算出一个提名图来确定 Aβ1-40 偏高的概率。在中位随访 57 个月期间，193 名患者（17.2%）死亡。Kaplan-Meier 分析显示，Aβ1-40 水平高于中位数（PPP=0.01）亚组患者的死亡风险较高。在包括整个队列的 Cox 多变量分析中，Aβ1-40 水平与年龄、高敏 C 反应蛋白水平、吸烟、肾小球滤过率 2、左心室射血分数降低和既往缺血事件一起预测死亡（危险比 1.03；P=0.01）。在 STEMI 亚队列中，Aβ1-40 与高龄、左心室射血分数降低、吸烟和高敏 C 反应蛋白升高一样，仍然是一个重要的预测因子。在NSTEMI患者中没有发现这种关联（P=0.17），这可能是由于队列规模较小和事件发生率较低所致：Aβ1-40是预测死亡的独立指标，可改善急性心肌梗死患者的风险分层。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Heart Association CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

9.40

自引率

1.90%

发文量

1749

审稿时长

12 weeks

期刊介绍： As an Open Access journal, JAHA - Journal of the American Heart Association is rapidly and freely available, accelerating the translation of strong science into effective practice. JAHA is an authoritative, peer-reviewed Open Access journal focusing on cardiovascular and cerebrovascular disease. JAHA provides a global forum for basic and clinical research and timely reviews on cardiovascular disease and stroke. As an Open Access journal, its content is free on publication to read, download, and share, accelerating the translation of strong science into effective practice.