title: Alkaline phosphatase and prognosis in patients with coronary artery disease.
abstract: BACKGROUND
  The evidence on the association between alkaline phosphatase (ALP) and prognosis of patients with coronary artery disease (CAD) is limited. The aim of this study was to assess the association of ALP with the risk of mortality or coronary events in patients with CAD.
  
  
  METHODS
  The study included 5540 patients with angiography-proven CAD treated with catheter-based coronary revascularization. Baseline ALP measurements were available for analysis in all patients. Patients were divided into three groups: a group with an ALP activity in the 1st tertile (ALP ≤ 65·5 U/L; n = 1855), a group with an ALP activity in the 2nd tertile (ALP > 65·5 to 85·7 U/L; n = 1839) and a group with an ALP in the 3rd tertile (ALP > 85·7 U/L; n = 1846). The primary outcome was all-cause mortality at 3-year follow-up.
  
  
  RESULTS
  All-cause deaths (number [Kaplan-Meier estimates]) occurred in 443 patients: 117 (7·2%), 130 (8·1%) and 196 deaths (11·8%) among patients of the 1st, 2nd and 3rd ALP tertiles (unadjusted hazard ratio [HR] = 1·33, 95% confidence interval [CI]: 1·19 to 1·50; P < 0·001, calculated per tertile increment in the ALP activity). After adjustment in multivariable Cox proportional hazards model, ALP was independently associated with the risk of all-cause mortality (adjusted HR = 1·33 [1·18-1·51], P < 0·001, calculated per unit increment in log ALP). The multivariable model for all-cause mortality with baseline variables without ALP had a C statistic of 0·820 [0·797-0·843] which increased to 0·825 [0·804-0·849] after ALP inclusion; delta C statistic 0·005 [0·001-0·011]; P < 0·001.
  
  
  CONCLUSIONS
  In patients with CAD, elevated ALP activity was independently associated with the risk of 3-year all-cause mortality.
authors.affiliation: Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany.
authors.forename: Gjin
authors.identifier: http://orcid.org/0000-0002-8725-055X
authors.initials: G
authors.lastname: Ndrepepa
authors.affiliation: Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany.
authors.forename: Erion
authors.initials: E
authors.lastname: Xhepa
authors.affiliation: Department of Laboratory Medicine, Deutsches Herzzentrum München, Technische Universität, Munich, Germany.
authors.forename: Siegmund
authors.initials: S
authors.lastname: Braun
authors.affiliation: Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cassese
authors.affiliation: Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Fusaro
authors.affiliation: Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany.|DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.
authors.forename: Heribert
authors.initials: H
authors.lastname: Schunkert
authors.affiliation: Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany.|DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.
authors.forename: Adnan
authors.initials: A
authors.lastname: Kastrati
mesh_terms: D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood*; D002423:Cause of Death; D003324:Coronary Artery Disease / Q000097:blood* / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D016016:Proportional Hazards Models
chemical_list: D000469:Alkaline Phosphatase
keywords: Alkaline phosphatase; coronary artery disease; mortality; prognosis