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Diagnostic and prognostic value of autoantibodies anti‐apolipoprotein A‐1 and anti‐phosphorylcholine in acute non‐ ST elevation myocardial infarction
Author(s) -
Rubini Gimenez Maria,
Pagano Sabrina,
Virzi Julien,
Montecucco Fabrizio,
Twerenbold Raphael,
Reichlin Tobias,
Wildi Karin,
Grueter Daniel,
Jaeger Cedric,
Haaf Philip,
Vuilleumier Nicolas,
Mueller Christian
Publication year - 2015
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.12411
Subject(s) - mace , medicine , autoantibody , myocardial infarction , receiver operating characteristic , area under the curve , gastroenterology , predictive value of tests , biomarker , cardiology , antibody , immunology , percutaneous coronary intervention , biochemistry , chemistry
Background Autoantibodies have been shown to play a critical role in predicting major adverse cardiovascular events in atherosclerotic patients. We aimed to assess the diagnostic accuracy of autoantibodies to apolipoprotein A‐1 (anti‐apoA‐1 IgG) and to phosphorylcholine (anti‐ PC IgM) for non‐ ST segment elevation acute myocardial infarction ( NSTEMI ) and to explore their potential prognostic value. Methods This prospective multicentre study included 1072 patients presenting to the emergency department for suspected NSTEMI . The final diagnosis was adjudicated by two independent cardiologists. For both antibodies alone or expressed as a ratio (anti‐apoA‐1 IgG/anti‐ PC IgM), we determined their (i) diagnostic accuracy for NSTEMI and (ii) prognostic accuracy for major adverse cardiovascular events ( MACE ) during 1‐year follow‐up. Results A total of 154 patients (14%) had a final diagnosis of NSTEMI . Diagnostic accuracy for the diagnosis of NSTEMI as quantified by the area under the receiver operating characteristics curve ( AUC ) was very low for both autoantibodies separately as well as combined as a ratio: AUC anti‐apoA‐1 IgG 0·50 (95% CI , 0·47–0·53, P = 0·99), AUC anti‐ PC IgM 0·53 (95% CI , 0·50–0·56, P = 0·30) and AUC of the ratio 0·52 (95% CI , 0·49–0·55, P = 0·47). Adding the anti‐apoA‐1 IgG/Anti‐ PC IgM ratio to hs‐ cTnT did not provide incremental diagnostic value over hs‐ cTnT alone. MACE occurred in 221 patients (21%) during follow‐up. The autoantibodies, separately or expressed as ratio, also had very low accuracy to predict MACE (p=ns). Conclusions Anti‐apoA‐1 IgG and anti‐ PC IgM autoantibodies did not have diagnostic or prognostic value in patients with NSTEMI .