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Prognostic value of urinary 11‐dehydro‐thromboxane B 2 for mortality: A cohort study of stable coronary artery disease patients treated with aspirin
Author(s) -
Vasudevan Anupama,
Tecson Kristen M.,
BennettFirmin Jeanna,
Bottiglieri Teodoro,
Lopez Luis R.,
Peterson Margarita,
Sathyamoorthy Mohanakrishnan,
Schiffmann Raphael,
Schussler Jeffrey M.,
Swift Caren,
Velasco Carlos E.,
McCullough Peter A.
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27437
Subject(s) - medicine , aspirin , coronary artery disease , prospective cohort study , cohort , creatinine , cardiology , urinary system , proportional hazards model , surgery
Aim There is a variable cardiovascular risk reduction attributable to aspirin because of individual differences in the suppression of thromboxane A 2 and its downstream metabolite 11‐dehydro‐thromboxane B 2 (11dhTxB 2 ). The aim of this study is to evaluate the optimal cut point of urinary 11dhTxB 2 for the risk of mortality in aspirin‐treated coronary artery disease (CAD) patients. Methods and Results This was a prospective cohort study including stable CAD patients who visited the Baylor Heart and Vascular Hospital in Dallas or the Texas Heart Hospital Baylor Plano, TX between 2010 and 2013. The outcome of all‐cause mortality was ascertained from chart review and automated sources. The 449 patients included in this analysis had a mean age of 66.1 ± 10.1 years. 67 (14.9%) patients died within 5 years; 56 (87.5%) of the 64 patients with known cause of death suffered a cardiovascular related mortality. Baseline ln(urinary 11dhTxB 2 /creatinine) ranged between 5.8 and 11.1 (median = 7.2) with the higher concentrations among those who died (median: 7.6) than those who survived (median = 7.2, P < 0.001). Using baseline ln(11dhTxB 2 ) to predict all‐cause mortality, the area under the curve was 0.70 (95% CI: 0.64–0.76). The optimal cut point was found to be ln(7.38) = 1597.8 pg/mg, which had the following decision statistics: sensitivity = 0.67, specificity = 0.62, positive predictive value = 0.24, negative predictive value = 0.92, and accuracy = 0.63. Conclusion Our data indicate the optimal cut point for urine 11dhTxB2 is 1597.8 (pg/mg) for the risk prediction of mortality over five years in stable patients with CAD patients treated with aspirin.