Butyrylcholinesterase predicts cardiac mortality in young patients with acute coronary syndrome.
BACKGROUND
The incidence of acute coronary syndrome (ACS) in young people (≤65 years) is continuously rising. While prognostic factors in ACS are well-investigated less attention has been paid to their age-dependent prognostic value and their particular relevance in younger patients. The aim of our study was to assess the age-dependent prognostic impact of butyrylcholinesterase (BChE).


METHODS
Retrospective cohort study including 624 patients with ACS. Patients were stratified by age into equal groups (n = 208) corresponding to "young patients" (45-64 years), "middle-aged patients" (65-84 years) and "old patients" (85-100 years). Cox regression hazard analysis was used to assess the influence of BChE on survival.


RESULTS
After a mean follow-up time of 4.0 (interquartile range [IQR] 2.0-6.4) years, 154 patients (24.7%) died due to a cardiac cause. In the overall cohort, BChE was indirectly associated with cardiac mortality-free survival (adjusted hazard ratio (HR): 0.70 (95% confidence interval [CI] 0.53-0.93, p = 0.01). The primary-analysis of BChE by age strata showed the strongest effect in the age group 45-64 years with an adjusted HR per 1-SD of 0.28 (95% CI 0.12-0.64, p = 0.003), a weaker association with mortality in middle aged (65-84 years: adjusted HR per 1-SD 0.66 [95% CI: 0.41-1.06], p = 0.087), and no association in older patients (85-100 years: adjusted HR per 1-SD 0.89 [95% CI: 0.58-1.38], p = 0.613).


CONCLUSIONS
BChE is a strong predictor for cardiac mortality specifically in younger patients with ACS aged between 45 and 64 years. No significant association of BChE with cardiac-mortality was detected in other age classes.
Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
Patrick
P
Sulzgruber
Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
Lorenz
L
Koller
Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Edwin L. Steele Laboratory, Dept. of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America.
Thomas
T
Reiberger
Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
Feras
F
El-Hamid
Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
Stefan
S
Forster
Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
David-Jonas
DJ
Rothgerber
Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
Georg
G
Goliasch
Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
Johann
J
Wojta
Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
Alexander
A
Niessner
D054058:Acute Coronary Syndrome / Q000201:enzymology* / Q000401:mortality*; D000328:Adult; D000368:Aged; D002091:Butyrylcholinesterase / Q000378:metabolism*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016019:Survival Analysis
D002091:Butyrylcholinesterase