Predictive value of soluble urokinase-type plasminogen activator receptor for mortality in patients with suspected myocardial infarction

Nils A Sörensen, Julius Nikorowitsch, Johannes T Neumann, Nicole Rübsamen, Alina Goßling, Tau S Hartikainen, Stefan Blankenberg, Dirk Westermann, Tanja Zeller, Mahir Karakas, Nils A Sörensen, Julius Nikorowitsch, Johannes T Neumann, Nicole Rübsamen, Alina Goßling, Tau S Hartikainen, Stefan Blankenberg, Dirk Westermann, Tanja Zeller, Mahir Karakas

Abstract

Background: Early risk stratification of patients with suspected acute myocardial infarction (AMI) constitutes an unmet need in current daily clinical practice. We aimed to evaluate the predictive value of soluble urokinase-type plasminogen activator receptor (suPAR) levels for 1-year mortality in patients with suspected AMI.

Methods and results: suPAR levels were determined in 1314 patients presenting to the emergency department with suspected AMI. Patients were followed up for 12 months to assess all-cause mortality. Of 1314 patients included, 308 were diagnosed with AMI. Median suPAR levels did not differ between subjects with AMI compared to non-AMI (3.5 ng/ml vs. 3.2 ng/ml, p = 0.066). suPAR levels reliably predicted all-cause mortality after 1 year. Hazard ratio for 1-year mortality was 12.6 (p < 0.001) in the quartile with the highest suPAR levels compared to the first quartile. The prognostic value for 6-month mortality was comparable to an established risk prediction model, the Global Registry of Acute Coronary Events (GRACE) score, with an AUC of 0.79 (95% CI 0.72-0.86) for the GRACE score and 0.77 (95% CI 0.69-0.84) for suPAR. Addition of suPAR improved the GRACE score, as shown by integrated discrimination improvement statistics of 0.036 (p = 0.03) suggesting a further discrimination of events from non-events by the addition of suPAR.

Conclusions: suPAR levels reliably predicted mortality in patients with suspected AMI.

Study registration: http://www.clinicaltrials.gov (NCT02355457).

Keywords: ACS; Mortality; Risk prediction; Soluble urokinase-type plasminogen activator receptor (suPAR).

Conflict of interest statement

Dr. Neumann received honoraria from Siemens and Abbott Diagnostics. Dr. Blankenberg received honoraria from Abbott Diagnostics, Siemens, Thermo Fisher, and Roche Diagnostics and is a consultant for Thermo Fisher. Dr. Westermann reports personal fees from Bayer, Boehringer-Ingelheim, Berlin Chemie, AstraZeneca, Biotronik and Novartis. Dr. Karakas received consultancy fees outside of the scope of this manuscript from Vifor Pharma, Amgen, Sanofi, and AstraZeneca, and furthermore Grant support from Vifor Pharma.

Figures

Fig. 1
Fig. 1
Kaplan–Meier survival analysis. Kaplan–Meier survival curves for all patients (a) and patients diagnosed as having AMI (b) stratified by quartiles of suPAR levels. AMI acute myocardial infarction, suPAR soluble urokinase plasminogen activator receptor
Fig. 2
Fig. 2
Comparison of the predictive value of suPAR and the GRACE score. ROC analyses for the prediction of 6-month mortality for GRACE score and suPAR in all patients (a) and only AMI patients (b). GRACE Global Registry of Acute Coronary Events, suPAR soluble urokinase plasminogen activator receptor

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