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अमूर्त

Head-to-Head Comparison of Auto-Antibodies for Cardiovascular Outcome Prediction after Myocardial Infarction: a Prospective Study

Nicolas Vuilleumier, Sabrina Pagano, Kenza Lahlou, Poncet Antoine, Emmanuel Charbonney, Gary L. Norman, Francois Mach and Pascale Roux-Lombard

Background:Atherosclerosis-related inflammation fulfils the three required Koch’s postulates to be considered as an autoimmune disease. Accordingly, several auto-antibodies have been associated with an increased cardiovascular (CV) risk suggesting that they could be of help for cardiovascular risk stratification in the future.

Aims:to compare the prognostic accuracies of auto-antibodies to β2 glycoprotein I (anti-β2GPI) domain I and IV, cardiolipin, apolipoproteinA-1 (anti-apoA-1 IgG), heat-shock protein 60 (anti-HSP-60), and to phosphorylcholine (anti-PC IgM) for 12-months major cardiovascular events (MACE) prediction after myocardial infarction (MI).

Methods:Auto-antibodies were prospectively assessed by ELISA in 221 MI patients without autoimmune diseases who all completed the 12-months follow-up. Prognostic accuracies were evaluated by receiving operating characteristic (ROC) curve analyses, and risk analyses were performed using Cox regression model.

Results:MACE rate was 14% during follow-up. Among the tested auto-antibodies, anti-apoA-1 IgG antibodies were found to be the only candidate significantly predicting subsequent MACE ((Area Under the Curve (AUC):0.65; p=0.007)). A non-significant trend was observed for anti-cardiolipin (AUC: 0.59; p=0.05) and anti-HSP-60 (AUC:0.58; p=0.06) antibodies. No association was retrieved for others auto-antibodies. Cox regression analyses indicated that anti-apoA-1 IgG positivity was associated to a 4-fold MACE risk increase, independently of the 10-year global Framingham risk-score (Hazard Ratio: 3.8; p=0.002)

Conclusions:In this head-to-head prospective comparison study performed on secondary prevention patients anti-apoA-1 IgG appeared as the candidate with the strongest and independent MACE prognostic accuracy in non-autoimmune settings.