title: Soluble form of membrane attack complex independently predicts mortality and cardiovascular events in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention.
abstract: BACKGROUND
  The complement system is an important mediator of inflammation, which plays a pivotal role in atherosclerosis and acute myocardial infarction (AMI). Animal studies suggest that activation of the complement cascade resulting in the formation of soluble membrane attack complex (sMAC), contributes to both atherosclerosis and plaque rupture and may be the direct cause of tissue damage related to ischemia/reperfusion injury. However clinical data of sMAC during an AMI is sparse. Accordingly the aim was to investigate the prognostic role of sMAC in patients with ST-segment elevation myocardial infarction (STEMI).
  
  
  METHODS
  We included 725 STEMI-patients admitted to a single, high-volume invasive heart centre, treated with primary percutaneous coronary intervention (PCI), from September 2006 to December 2008. Blood samples were drawn immediately before PCI. Plasma sMAC was measured using an in-house immunoassay. Endpoints were all-cause mortality (n = 62) and the combined endpoint (n = 122) of major cardiovascular events (MACE) defined as cardiovascular mortality and admission due recurrent AMI or heart failure. Follow-up time was 12 months.
  
  
  RESULTS
  During 12 months of follow-up 62 patients died from all causes and 122 patients reached the combined end-point of MACE. Patients with high sMAC (>75th percentile) had increased risk of both all-cause mortality and MACE. Even after adjustment for confounding risk factors by Cox-regression analyses, high levels of sMAC remained an independent predictor of all-cause mortality (hazard ratio 1.81 [95% CI 1.06-3.06; P = .029]) and MACE (hazard ratio 1.70 [95% CI 1.16-2.48; P = .006]).
  
  
  CONCLUSIONS
  High plasma sMAC independently predicts all-cause mortality and MACE in STEMI-patients treated with PCI.
authors.affiliation: Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark. soerenli@hotmail.com
authors.forename: Søren
authors.initials: S
authors.lastname: Lindberg
authors.forename: Sune H
authors.initials: SH
authors.lastname: Pedersen
authors.forename: Rasmus
authors.initials: R
authors.lastname: Mogelvang
authors.forename: Søren
authors.initials: S
authors.lastname: Galatius
authors.forename: Allan
authors.initials: A
authors.lastname: Flyvbjerg
authors.forename: Jan Skov
authors.initials: JS
authors.lastname: Jensen
authors.forename: Mette
authors.initials: M
authors.lastname: Bjerre
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015897:Comorbidity; D015938:Complement Membrane Attack Complex / Q000378:metabolism*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models
chemical_list: D015415:Biomarkers; D015938:Complement Membrane Attack Complex