title: Low Serum-Butyrylcholinesterase Activity as a Prognostic Marker of Mortality Associates with Poor Cardiac Function in Acute Myocardial Infarction.
abstract: BACKGROUND
  Recently, butyrylcholinesterase (BChE) activity seems to have an independent prognostic role in acute coronary syndrome (ACS). However, the underlying mechanisms remain unclear. A previous study showed that serum BChE activity had a diagnostic value for chronic heart failure. This raises a question: whether BChE activity is associated with cardiac function in ACS, and if so, is this association related to the predictive value of BChE? The aim of this study was to determine the association between BChE activity with cardiac function assessed by Killip class and left ventricular ejection fraction (LVEF) in acute myocardial infarction (AMI) and to evaluate the independent prognostic role of BChE with consideration of these two indicators.
  
  
  METHODS
  A total of 350 consecutive patients with AMI were retrospectively included. Serum BChE activity was measured upon admission. All patients were divided into two groups according to median value of BChE activity. All-cause death was defined as endpoint. The prognostic value of mortality was assessed by using Cox regression analysis.
  
  
  RESULTS
  BChE activity was higher in patients with low Killip class (I or II) than that in those with high Killip class (III and IV) (7.0 +/- 1.3 or 7.0 +/- 1.5 vs. 6.2 +/- 1.6, p < 0.01). BChE activity was positively correlated with LVEF (r = 0.24, p < 0.001). During a mean follow-up period of 29 +/- 7 months, 25 patients died. BChE activity was significantly higher in surviving patients compared with non-surviving ones (7.0 +/- 1.4 vs. 5.7 +/- 1.3, p < 0.001). The survival rates were 89% and 97%, respectively, in the low and high groups of BChE activity. In a multivariate Cox proportional hazards regression analysis, after adjusting for potential confounders, BChE activity was an independent predictor of mortality after myocardial infarction [Hazard Ratio (HR) 0.65, 95% CI 0.46 - 0.91; p = 0.0131. However, when introducing Killip class and LVEF into the model, BChE activity was not in the equation.
  
  
  CONCLUSIONS
  Low BChE activity as a predictor of mortality in AMI might be related to its association with poor cardiac function.
authors.forename: Limin
authors.initials: L
authors.lastname: Sun
authors.forename: Ximing
authors.initials: X
authors.lastname: Qi
authors.forename: Qiang
authors.initials: Q
authors.lastname: Tan
authors.forename: Hongmei
authors.initials: H
authors.lastname: Yang
authors.forename: Xiangqian
authors.initials: X
authors.lastname: Qi
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002091:Butyrylcholinesterase / Q000097:blood*; D015536:Down-Regulation; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000201:enzymology / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D002091:Butyrylcholinesterase