Serum tryptase detected during acute coronary syndrome is significantly related to the development of major adverse cardiovascular events after 2 years

Elide Anna Pastorello, Laura Farioli, Laura Michelina Losappio, Nuccia Morici, Matteo Di Biase, Michele Nichelatti, Jan Walter Schroeder, Luca Balossi, Silvio Klugmann, Elide Anna Pastorello, Laura Farioli, Laura Michelina Losappio, Nuccia Morici, Matteo Di Biase, Michele Nichelatti, Jan Walter Schroeder, Luca Balossi, Silvio Klugmann

Abstract

Background: One of the greatest challenges in cardiovascular medicine is to define the best tools for performing an accurate risk stratification for the recurrence of ischemic events in acute coronary syndrome (ACS) patients.

Methods: We followed 65 ACS patients enrolled in a previous pilot study for 2 years after being discharged, focusing on the occurrence of major adverse cardiovascular events (MACE). The relationship between serum tryptase levels on admission, SYNergy between percutaneous coronary intervention with the TAXUS drug-eluting stent and the cardiac surgery score (SX-score), cardiovascular complexity and MACE at 2 years follow-up were analyzed.

Results: The ACS population was divided in two groups: patients with MACE (n = 23) and patients without MACE (n = 42). The tryptase measurement at admission (T0) and at discharge (T3) and SX-score were higher in patients who experienced MACE than in those without (p = 0.0001, p < 0.0001 and p = 0.006, respectively). Conversely, we found no significant association between MACE and C-reactive protein (CRP), and between MACE and maximum level of high-sensitivity troponin (hs-Tn) values. Among all patients with MACE, 96% belonged to the group that presented with cardiovascular complexity at the beginning of ACS index admission (p < 0.0001). The predictive accuracy of serum tryptase for MACE at follow up set at the cut-off point of 4.95 ng/ml at T0 and of 5.2 ng/ml at T3. Interestingly, patients with both the above cut-off tryptase values at T0 and at T3 presented a 1320% increase in the odds of developing MACE (p < 0.0001).

Conclusion: In ACS patients, serum tryptase measured during index admission is significantly correlated to the development of MACE up to 2 years, demonstrating a possible long-term prognostic role of this biomarker.

Keywords: Acute coronary syndrome; Biomarker; Major adverse cardiovascular events; Mast cell; Tryptase.

Figures

Figure 1
Figure 1
ROC curves reporting AUC calculated at the time of acute event for tryptase,cardiac troponin, CRP, and SX-score, with respect to MACE: AUC of tryptase and SX-score appear significantly higher than the other AUCs. ROC analysis to search for cut-off values of the different markers predictive of MACE.
Figure 2
Figure 2
Box plot for tryptase at T3, CRP, cardiac troponin measurements, and SX-score in MACE and non-MACE patients. The p values were calculated by the Mann–Whitney test. Comparison of the measurements of the analysed markers in patients with and without MACE.

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