Author + information
- Takahiro Fujii1,
- Ippei Watanabe1,
- Daiga Saito1,
- Junko Tatebe1,
- Toshisuke Morita1 and
- Takanori Ikeda2
This study sought to evaluate if indoxyl sulfate (IS), a protein bound uremic toxin predicts prognosis after acute coronary syndrome (ACS).
We prospectively enrolled 98 patients who underwent primary percutaneous coronary intervention for ACS. Patients on hemodialysis were excluded. The endpoint of this study was 6-months composite events including death, non-fatal myocardial infarction, heart failure requiring hospitalization and major bleeding. The independent predictors were identified by a multivariate logistic regression analysis. The incremental prognostic value of biomarkers added to GRACE risk score was assessed by receiver operating characteristic (ROC), net reclassification improvement (NRI) and integrated discrimination improvement (IDI).
Serum IS was significantly higher in subjects who developed composite events (0.06 vs 0.14 mg/dl, p<0.001). After adjustment by confounding factors, multivariate analysis found IS (OR:41.4, 95% CI:1.26-1360, p<0.05), hemoglobin (OR:0.52, 95% CI: 0.31-0.86, p<0.05), loop diuretics (OR: 67.6, 95% CI: 4.04-1130, p<0.01) and atrial fibrillation (OR: 23.4, 95% CI: 1.60-342.0, p<0.05) were independent predictive factors. Although neither IS nor hemoglobin was independently associated with the improvement of risk stratification, their combination significantly conferred an additive value to GRACE risk score for predicting the incidence of composite events (area under the curve :0.765 vs 0.841; Z = -2.1577, p-value = 0.03, NRI :0.8905: p< 0.001 and IDI 0.1958: p=0.02).
IS was a prognostic factor after ACS. The Combination of IS and hemoglobin improved the risk stratification in addition to GRACE risk score, suggesting IS may play an important role in the interaction between impaired renal function and anemia in patients with ACS.
CORONARY: PCI Outcomes