title: Whole blood choline and plasma choline in acute coronary syndromes: prognostic and pathophysiological implications.
abstract: BACKGROUND
  Whole blood choline (WBCHO) and plasma choline (PLCHO) concentrations increase rapidly after stimulation of phospholipase D in acute coronary syndromes (ACS). Early risk-stratification was analyzed in 217 patients with suspected ACS and a negative admission troponin T (<0.03 microg/L).
  
  
  METHODS
  WBCHO and PLCHO were measured using high-performance-liquid-chromatography mass spectrometry. Major cardiac events (MACE) were defined as cardiac death/arrest, coronary intervention or myocardial infarction (MI).
  
  
  RESULTS
  WBCHO (> or = 28.2 micromol/L) was predictive for MACE (hazard ratio [HR] 2.7; p<0.001), cardiac death/arrest (HR 4.2; p=0.015), heart failure (HR 2.8; p=0.003), coronary intervention (HR 2.1; p=0.01) and MI (HR 8.4; p=0.002) after 30 days. PLCHO (> or = 25.0 micromol/L) was predictive for MACE (HR 2.6; p=0.005), cardiac death/arrest (HR 15.7; p<0.001), heart failure (HR 6.0; p<0.001) but not for coronary intervention and MI. WBCHO and PLCHO were predictive for MACE in multivariate analysis (Odds ratio [OR] 2.7, p=0.009 and OR 3.3, p=0.03) independently of age, gender, prior MI, coronary risk factors and ECG.
  
  
  CONCLUSIONS
  WBCHO and PLCHO are significant and independent predictors of major cardiac events in admission troponin T negative acute coronary syndromes. Both are predictive for events related to tissue ischemia and WBCHO is capable of detecting risks associated with coronary plaque instability.
authors.affiliation: Department of Medicine, Internal Intensive Care and Nephrology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany. oliver.danne@charite.de
authors.forename: Oliver
authors.initials: O
authors.lastname: Danne
authors.forename: Christian
authors.initials: C
authors.lastname: Lueders
authors.forename: Christian
authors.initials: C
authors.lastname: Storm
authors.forename: Ulrich
authors.initials: U
authors.lastname: Frei
authors.forename: Martin
authors.initials: M
authors.lastname: Möckel
mesh_terms: D000368:Aged; D002794:Choline / Q000097:blood*; D002851:Chromatography, High Pressure Liquid; D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis; D003327:Coronary Disease / Q000097:blood* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D013058:Mass Spectrometry; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000175:diagnosis; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D020107:Troponin T / Q000097:blood
chemical_list: D020107:Troponin T; D002794:Choline