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Vitronectin (VN), a 459 aminoacid long glycoprotein with a mass of 75 kDa, is found in plasma, extracellular matrix and α granules of platelets. Plasma VN levels were found to be elevated in patients with coronary artery disease (CAD), and a positive correlation between VN levels and CAD severity has been demonstrated. VN was also shown to be an independent predictor of adverse cardiovascular outcomes following acute stenting in patients with acute myocardial infarction (AMI) or stable angına.
The aim of this study was to assess prognostic significance of serum VN levels at admission in patients with ACS.
Sixty-two patients (40 men, mean age 59.9±10.3 years and 22 women, mean age 68.9±11.2 years), who had been admitted to coronary care unit with first time diagnosis of ACS (ST elevation myocardial infarction [STEMI], non-ST elevation myocardial infarction [NSTEMI]) were consecutively included in the study.The control group consisted of 18 stable patients in whom normal coronary arteries were documented in coronary angiography. Patients were divided into two sub-groups as STEMI and NSTEMI and they were followed up for six months for major adverse cardiovascular events (MACE) consisting of cardiovascular mortality, re-infarction, hospitalization for decompensated heart failure and life threatening arrhythmias. Blood samples were drawn within 6 hours after onset of chest pain and serum VN, high sensitive C-reactive protein (hs-CRP) and N-terminal probrain natriuretic peptide (NT-proBNP) levels were measured using an enzyme immunoassay method. Also, TIMI and GRACE clinical risk scores were calculated on admission for all ACS patients.
The mean VN level in patients with MACE at six months was significantly higher (12.09 μg/ml +/- 20.79 μg/ml vs. 3.74 μg/ml +/- 7.48 μg/ml, p<0.001) compared to the rest of the patient group. Patients in the upper two VN quartiles had significantly higher in-hospital (p=0.026) and six months (p<0.001) MACE rates compared to the patients in the lower two quartiles. Using ROC analysis, a cut-off VN value of 2.16 μg/ml was able to predict MACE at six months with a positive predictive value of 75%, and a negative predictive value of 76%, AUC: 0.76, %95 CI: 0.64-0.88 (p<0.001) (Figure). VN was also able to predict MACE independent of other prognostic markers like age, hs-CRP, pro-BNP, TIMI, GRACE, and LVEF in multivariate regression analysis (p=0.001).
VN levels on admission predict in-hospital and medium-term MACE in patients with ACS independent of conventional risk predictors. VN may have a utility as a prognostic marker in patients with ACS.