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Impact of soluble fms-like tyrosine kinase-1 and placental growth factor serum levels for risk stratification and early diagnosis in patients with suspected acute myocardial infarction

Hochholzer, Willibald ; Reichlin, Tobias ; Stelzig, Claudia ; Hochholzer, Kirsten ; Meissner, Julia ; Breidthardt, Tobias ; Reiter, Miriam ; Duehsler, Bettina ; Freidank, Heike ; Winkler, Katrin ; Twerenbold, Raphael ; Mueller, Christian

In: European Heart Journal, 2011, vol. 32, no. 3, p. 326-335

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    Titre
    • Impact of soluble fms-like tyrosine kinase-1 and placental growth factor serum levels for risk stratification and early diagnosis in patients with suspected acute myocardial infarction
    Auteur
    • Hochholzer, Willibald. Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
    • Reichlin, Tobias. Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
    • Stelzig, Claudia. Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
    • Hochholzer, Kirsten. Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
    • Meissner, Julia. Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
    • Breidthardt, Tobias. Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
    • Reiter, Miriam. Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
    • Duehsler, Bettina. Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
    • Freidank, Heike. Department of Laboratory Medicine, University Hospital Basel, Basel, Switzerland
    • Winkler, Katrin. Servicio de Pneumologia, Hospital del Mar—IMIM, UPF, CIBERES, ISC III, Barcelona, Spain
    • Twerenbold, Raphael. Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
    • Mueller, Christian. Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
    Type de document
    • Postprint
    Langue
    • Inglese
    Publié dans
    • European Heart Journal, 2011, vol. 32, no. 3, p. 326-335. Oxford University Press
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:299551
    Summary
    Aims Angiogenic factors play an important role in the development of atherosclerosis and show pronounced changes during acute myocardial infarction (AMI). We analysed the impact of placental growth factor (PlGF) and its endogen opponent, soluble fms-like tyrosine kinase-1 (sFlt-1), on clinical outcome and the early diagnosis of AMI. Methods and results This multicentre study enrolled patients presenting with symptoms suggestive of AMI. The final diagnosis was adjudicated by two independent physicians. Levels of sFlt-1 and PlGF were compared with results of a standard troponin T and a novel high-sensitive troponin (hsTnT) assay. Of the 763 patients enrolled, 132 were diagnosed with AMI. Multivariable Cox regression analysis demonstrated sFlt-1 >84 ng/L [hazard ratios (HR) 2.6, 95% confidence intervals (CI) 1.2-5.4, P=0.01] and PlGF >20 ng/L (HR 3.6, 95% CI 1.3-10.4, P=0.02) as predictors for mortality during 1-year follow-up, independent from information provided by troponin T and N-terminal pro-B-type natriuretic peptide (NT-proBNP). However, only sFlt-1 persisted as independent predictor for mortality when analysed together with hsTnT and NT-proBNP, and after adjusting for significant clinical parameters. For the diagnosis of AMI, the combination of troponin T and sFlt-1 improved the performance of troponin T alone and led to a negative predictive value of 98.3% already at time of presentation. However, sFlt-1 and PlGF added only limited diagnostic information when used together with hsTnT. Conclusion Only sFlt-1 but not PlGF provides overall independent prognostic information in patients presenting with symptoms suggestive of AMI. After the introduction of hsTnT in clinical routine, sFlt-1 and PlGF can only add limited diagnostic information for the detection or exclusion of AMI. Clinical Trial Registration Information: ClinicalTrials.gov, NCT00470587