title: Prognostic value of TNF-related apoptosis inducing ligand (TRAIL) in acute coronary syndrome patients.
abstract: BACKGROUND
  Apoptosis plays an important role in the development of heart failure. The aim of the prospectively designed study was to assess whether the concentration of apoptotic markers apoptosis-stimulating fragment (Fas, CD95/APO-1) and tumor necrosis factor-related apoptosis inducing ligand (TRAIL) can predict prognosis in patients with acute coronary syndromes.
  
  
  METHODS
  The concentrations of soluble Fas and TRAIL were determined in 295 patients with acute coronary syndromes. The status of all patients was evaluated at 6 months. The primary goal was a composite end-point of death and hospitalization for heart failure. The secondary end-points were re-MI, death alone and stroke alone.
  
  
  RESULTS
  During the median follow-up of 6 months, 26 patients experienced the composite end-point. Using multivariate logistic regression, the concentration of TRAIL was the strongest significant and independent predictor of composite end-point (OR 0.11 (95% CI 0.03-0.45), p = 0.002). Low concentration was associated with poor prognosis of patients. Other significant predictors of composite end-point were serum creatinine (OR 7.7 (95% CI 1.1-54.5, p = 0.041) and complete revascularization (OR 0.19 (95% CI 0.05-0.78, p = 0.02). Independent significant predictors of death in the multivariate analysis were the concentration of TRAIL (OR 0.053 (95% CI 0.004-0.744), p = 0.029), older age (OR 1.20 (95% CI 1.02-1.41, p = 0.026) and serum creatinine (OR 15.1 (95% CI 1.56-145.2), p = 0.0193). Re-MI or stroke could not be predicted by any combination of obtained parameters.
  
  
  CONCLUSIONS
  Low concentrations of soluble TRAIL represent a strong predictor of a poor prognosis in patients with acute coronary syndrome. The predictive value of TRAIL concentration is independent of age, ejection fraction, index peak troponin level, concentration of BNP or serum creatinine.
authors: Cardiocenter, Department of Cardiology, 3 Medical School, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic. pavel.osmancik@gmail.com
authors: Pavel
authors: P
authors: Osmancik
authors: Elena
authors: E
authors: Teringova
authors: Petr
authors: P
authors: Tousek
authors: Petra
authors: P
authors: Paulu
authors: Petr
authors: P
authors: Widimsky
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D000368:Aged; D017209:Apoptosis; D015415:Biomarkers / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D011379:Prognosis; D012372:ROC Curve; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D053221:TNF-Related Apoptosis-Inducing Ligand / Q000097:blood*; D019014:fas Receptor / Q000097:blood
chemical_list: D015415:Biomarkers; D053221:TNF-Related Apoptosis-Inducing Ligand; D019014:fas Receptor