可溶性ウロキナーゼプラスミノーゲンアクチベーター受容体の急性冠症候群における長期予後バイオマーカーとしての検討

Soluble urokinase plasminogen activator receptor as a long-term prognostic biomarker in acute coronary syndromes.

• Óscar Manuel Peiró
• German Cediel
• Gil Bonet
• Sergio Rojas
• Verónica Quintern
• Anna Carrasquer
• Maribel González-Del-Hoyo
• Esther Sanz
• Alfredo Bardají

抄録

本研究の目的は，急性冠症候群（ACS）における可溶性ウロキナーゼプラスミノーゲンアクチベーター受容体（suPAR）の長期予後を解析することである．冠動脈造影を受けたACS患者340例を対象に，血漿中のsuPAR濃度を測定した．患者を低血糖値（2.6ng/mL未満）と高血糖値（2.6ng/mL以上）に分類し，長期イベントを評価した．suPAR濃度が高いほど心血管系危険因子の有病率が上昇した。多変量調整後、suPAR濃度が2.6ng/mL以上では、全死因死亡（HR 2.3；95％CI 1.2～4.4；=.017）、主要有害心血管イベント（MACE）（HR 1.7；95％CI 1.1～2.5；=.020）、心不全（HR 4.1；95％CI 1.3～12.6；=.015）のリスク増加と独立して関連していたが、心筋梗塞とは関連していなかった。長期的な全死因死亡については、臨床モデルにsuPARを追加することで、再分類と識別が有意に改善されました。ACSの設定では、suPARは長期的な全死因死亡、心不全、MACEと関連し、従来のリスク因子を超えた増分的な予後評価を提供する。

The aim of our study was to analyse the long-term prognostic value of soluble urokinase plasminogen activator receptor (suPAR) in the setting of an acute coronary syndrome (ACS). We included 340 patients with an ACS who underwent coronary angiography and plasma suPAR concentration was measured. Patients were classified into low suPAR concentrations (<2.6 ng/mL) and high suPAR concentrations (≥2.6 ng/mL) and long-term events were evaluated. suPAR prognostic value was assessed beyond a clinical model that included age, GRACE score, estimated glomerular filtration rate, cardiac troponin-I peak and left ventricular ejection fraction <40%. Higher suPAR concentrations were associated with an increased prevalence of cardiovascular risk factors. After multivariate adjustment, suPAR ≥2.6 ng/mL were independently associated with an increased risk of all-cause death (HR 2.3; 95%CI 1.2-4.4;  = .017), major adverse cardiovascular events (MACE) (HR 1.7; 95%CI 1.1-2.5;  = .020) and heart failure (HR 4.1; 95%CI 1.3-12.6;  = .015), but not with myocardial infarction. For long-term all-cause death significant improvement of reclassification and discrimination were seen after addition of suPAR to a clinical model. In the setting of an ACS, suPAR is associated with long-term all-cause death, heart failure and MACE, and provides incremental prognostic value beyond traditional risks factors.