title: Butyrylcholinesterase activity predicts long-term survival in patients with coronary artery disease.
abstract: BACKGROUND
  Low serum butyrylcholinesterase activity was associated with all-cause and cardiovascular mortality in a community-based study; however, there are no data from investigations of the long-term effects of butyrylcholinesterase on mortality in patients with diagnosed coronary artery disease (CAD). We therefore assessed the effect of butyrylcholinesterase activity on the outcomes of patients with CAD.
  
  
  RESULTS
  We prospectively included 720 patients in our study: 293 patients with stable CAD and 427 patients with acute coronary syndrome. During a median follow-up of 11.3 years corresponding to 6469 overall person-years, 278 deaths (38.6%) were recorded. We detected a significant and independent protective effect of butyrylcholinesterase on all-cause mortality [adjusted hazard ratio (HR) for a 1-SD increase, 0.62; 95% CI, 0.54-0.71; P < 0.001] and cardiovascular mortality (adjusted HR, 0.64; 95% CI, 0.54-0.76; P < 0.001) in a Cox proportional hazards regression analysis. The 10-year survival rates were 42%, 74%, and 87% in the first, second, and third tertiles of butyrylcholinesterase activity. The presentation of CAD affected the effect of butyrylcholinesterase on mortality (P for interaction = 0.012), with a stronger association found in patients with stable CAD (adjusted HR, 0.56; 95% CI, 0.45-0.70; P < 0.001).
  
  
  CONCLUSIONS
  Our study demonstrates a strong inverse association between butyrylcholinesterase activity and long-term outcome in patients with known CAD. Because butyrylcholinesterase added predictive information after adjustment for established cardiovascular risk factors, additional underlying pathophysiological mechanisms and the potential applicability of butyrylcholinesterase activity for secondary risk prediction needs to be addressed in future studies.
authors.affiliation: Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Goliasch
authors.forename: Arvand
authors.initials: A
authors.lastname: Haschemi
authors.forename: Rodrig
authors.initials: R
authors.lastname: Marculescu
authors.forename: Georg
authors.initials: G
authors.lastname: Endler
authors.forename: Gerald
authors.initials: G
authors.lastname: Maurer
authors.forename: Oswald
authors.initials: O
authors.lastname: Wagner
authors.forename: Kurt
authors.initials: K
authors.lastname: Huber
authors.forename: Christine
authors.initials: C
authors.lastname: Mannhalter
authors.forename: Alexander
authors.initials: A
authors.lastname: Niessner
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000201:enzymology / Q000401:mortality; D000368:Aged; D002091:Butyrylcholinesterase / Q000097:blood*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000201:enzymology / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate
chemical_list: D002091:Butyrylcholinesterase