Dickkopf-1 as a novel predictor is associated with risk stratification by GRACE risk scores for predictive value in patients with acute coronary syndrome: a retrospective research

Lin Wang, Xiao Bo Hu, Wei Zhang, Lin Di Wu, Yu Sheng Liu, Bo Hu, Cheng Long Bi, Yi Fei Chen, Xin Xin Liu, Cheng Ge, Yun Zhang, Mei Zhang, Lin Wang, Xiao Bo Hu, Wei Zhang, Lin Di Wu, Yu Sheng Liu, Bo Hu, Cheng Long Bi, Yi Fei Chen, Xin Xin Liu, Cheng Ge, Yun Zhang, Mei Zhang

Abstract

Objective: Dickkopf-1 (DKK-1), a major regulator of the Wnt pathway, plays an important role in cardiovascular disease. However, no study has evaluated the association of DKK-1 and acute coronary syndrome (ACS). We investigated this association and whether the Global Registry of Acute Coronary Events (GRACE) hospital-discharge risk score predicting major adverse cardiac events (MACE) can be improved by adding the DKK-1 value.

Methods: We enrolled 291 patients (46 with ST-segment elevation myocardial infarction [STEMI] and 245 with non-ST elevated ACS [NSTE-ACS]) who were divided into groups by tertiles of baseline plasma DKK-1 level measured by ELISA. The GRACE risk score was calculated and predictive value alone and together with DKK-1 and/or high-sensitivity C-reactive protein (hs-CRP) level were assessed, respectively.

Results: Compared with patients with NSTE-ACS, those with STEMI had higher plasma DKK-1 level at baseline (P = 0.006). Plasma DKK-1 level was correlated with hs-CRP level (r = 0.295, P<0.001) and was greater with high than intermediate or low GRACE scores (P = 0.002 and P<0.001, respectively). We found 44 (15.1%) MACEs during a median 2-year follow-up. DKK-1 levels were higher for patients with than without events (P<0.001). The rate of MACE increased with increasing DKK-1 level (P<0.001). The area under the receiver operating characteristic curve for GRACE score with MACE was 0.524 and improved to 0.791 with the addition of hs-CRP level, 0.775 with the addition of DKK-1 level and 0.847 with both values added.

Conclusions: DKK-1 is an independent predictor of long-term MACE of patients with ACS. The long-term predictive ability of post-discharge GRACE score may be enhanced by adding DKK-1 level.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Flow chart of the study.
Figure 1. Flow chart of the study.
Figure 2. Log DKK-1 with ACS patients.
Figure 2. Log DKK-1 with ACS patients.
(A) Relation of log DKK-1 level and high-sensitivity C-reactive protein (hs-CRP) level in ACS patients (P<0.001). The cutoff point for hs-CRP level was 3 pg/ml. (B) Log DKK-1 level in different ACS groups.
Figure 3. Association of tertiles of DKK-1…
Figure 3. Association of tertiles of DKK-1 level and major adverse coronary events (MACE) (P<0.001).
Figure 4. Log DKK-1 in patients with…
Figure 4. Log DKK-1 in patients with ACS in 3 subgroups by GRACE score.
Data are median (range).
Figure 5. Receiver operating characteristic curve analysis…
Figure 5. Receiver operating characteristic curve analysis of predictive models for ACS patients.
The sensitivity and specificity for each model was 56.8% and 51.4%; 84.1% and 64.4%; 75.0% and 63.2%; 81.8% and 71.7%.

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Source: PubMed

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