Decreased activated protein C levels as a clinical predictor in patients with ST-elevation myocardial infarction.
Am Heart J. 2008 Nov;156(5):931-8
Authors: Chiba N, Nagao K, Mukoyama T, Tominaga Y, Tanjoh K
BACKGROUND: Circulating markers that indicate atherosclerotic plaque instability may have diagnostic and prognostic value in patients with acute coronary syndromes. We evaluated activated protein C (APC), which has antithrombotic, anti-inflammatory, and profibrinolytic properties, as a possible clinical predictor in ST-elevation myocardial infarction (STEMI), including return of spontaneous circulation after sudden cardiac arrest. METHODS: Patients with STEMI whose APC level was measured upon arrival at the emergency room were enrolled in this study (n = 335). The primary end point was inhospital death from any cause. RESULTS: The APC level ranged from 29% to 142% with a median of 80%. The unadjusted death rate increased in a stepwise fashion with decreasing APC levels (33.7% in quartile 1, 12.7% in 2, 6.0% in 3, and 3.6% in 4, P < .001). This association remained significant in subgroups of patients with STEMI only (P = .04) or with return of spontaneous circulation (P = .01). After adjusting for independent predictors of inhospital death, the odds ratio for death among those in the first quartile of APC levels was 9.4 (95% CI 1.1-81.6, P = .04). A cutoff APC level of 65% had the highest combined sensitivity and specificity in predicting death. CONCLUSIONS: Measuring APC levels provides predictive information for use in risk stratification across the STEMI spectrum. Decreased APC levels may be a unifying feature among patients at high risk for death after STEMI.
PMID: 19061709 [PubMed - in process]