title: Usefulness of Beta2-Microglobulin as a Predictor of All-Cause and Nonculprit Lesion-Related Cardiovascular Events in Acute Coronary Syndromes (from the PROSPECT Study).
abstract: In the Providing Regional Observations to Study Predictors of Events in the Coronary Tree (PROSPECT) study, plaque burden, plaque composition, and minimal luminal area were associated with an increased risk of adverse cardiovascular events arising from untreated atherosclerotic lesions (vulnerable plaques) in patients with acute coronary syndromes (ACS). We sought to evaluate the utility of biomarker profiling and clinical risk factors to predict 3-year all-cause and nonculprit lesion-related major adverse cardiac events (MACEs). Of 697 patients who underwent successful percutaneous coronary intervention (PCI) for ACS, an array of 28 baseline biomarkers was analyzed. Median follow-up was 3.4 years. Beta2-microglobulin displayed the strongest predictive power of all variables assessed for all-cause and nonculprit lesion-related MACE. In a classification and regression tree analysis, patients with beta2-microglobulin >1.92 mg/L had an estimated 28.7% 3-year incidence of all-cause MACE; C-peptide <1.32 ng/ml was associated with a further increase in MACE to 51.2%. In a classification and regression tree analysis for untreated nonculprit lesion-related MACE, beta2-microglobulin >1.92 mg/L identified a cohort with a 3-year rate of 18.5%, and C-peptide <2.22 ng/ml was associated with a further increase to 25.5%. By multivariable analysis, beta2-microglobulin was the strongest predictor of all-cause and nonculprit MACE during follow-up. High-density lipoprotein (HDL), transferrin, and history of angina pectoris were also independent predictors of all-cause MACE, and HDL was an independent predictor of nonculprit MACE. In conclusion, in the PROSPECT study, beta2-microglobulin strongly predicted all-cause and nonculprit lesion-related MACE within 3 years after PCI in ACS. C-peptide and HDL provided further risk stratification to identify angiographically mild nonculprit lesions prone to future MACE.
authors.affiliation: Division of Emergency Medicine and Chest Pain Units (CPUS), Charité Campus Virchow Klinikum and Mitte, Berlin, Germany. Electronic address: martin.moeckel@charite.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Möckel
authors.affiliation: James Cook University, Townsville, Australia; Tropical Health Solutions Pty Ltd, Townsville, Australia.
authors.forename: Reinhold
authors.initials: R
authors.lastname: Muller
authors.affiliation: Division of Emergency Medicine and Chest Pain Units (CPUS), Charité Campus Virchow Klinikum and Mitte, Berlin, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Searle
authors.affiliation: Division of Emergency Medicine and Chest Pain Units (CPUS), Charité Campus Virchow Klinikum and Mitte, Berlin, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Slagman
authors.affiliation: Cardiovascular Center Aalst, Aalst, Belgium.
authors.forename: Bernard
authors.initials: B
authors.lastname: De Bruyne
authors.affiliation: Interventional Cardiology, Thoraxcenter, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Patrick
authors.initials: P
authors.lastname: Serruys
authors.affiliation: Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York.
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.affiliation: Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York.
authors.forename: Ke
authors.initials: K
authors.lastname: Xu
authors.affiliation: Division of Emergency Medicine and Chest Pain Units (CPUS), Charité Campus Virchow Klinikum and Mitte, Berlin, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Holert
authors.affiliation: Division of Emergency Medicine and Chest Pain Units (CPUS), Charité Campus Virchow Klinikum and Mitte, Berlin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Müller
authors.affiliation: Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York.
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
authors.affiliation: Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York.
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000150:complications*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D001613:beta 2-Microglobulin / Q000097:blood*
chemical_list: D015415:Biomarkers; D001613:beta 2-Microglobulin