Prognostic Value of TNF-Related Apoptosis Inducing Ligand (TRAIL) in Acute Coronary Syndrome Patients

• Published in: PloS one Vol. 8; no. 2; p. e53860
• Main Authors: Osmancik, Pavel, Teringova, Elena, Tousek, Petr, Paulu, Petra, Widimsky, Petr
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 18.02.2013; Public Library of Science (PLoS)
• Subjects: Acute Coronary Syndrome - blood; Acute Coronary Syndrome - complications; Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - mortality; Acute coronary syndromes; Aged; Analysis; Angina pectoris; Apoptosis; Atherosclerosis; Biochemistry; Biomarkers - blood; Calcium-binding protein; Cardiac patients; Cardiology; CD95 antigen; Coronary heart disease; Coronary vessels; Creatinine; Death; Disorders; fas Receptor - blood; Female; Gene expression; Heart attacks; Heart diseases; Heart failure; Heart Failure - etiology; Hematology; Humans; Ligands; Low concentrations; Male; Medical imaging; Medical prognosis; Medical research; Medical schools; Medicine; Middle Aged; Mortality; Multivariate analysis; Myocardial Infarction - etiology; Patients; Prognosis; Regression analysis; Risk Factors; ROC Curve; Stroke - etiology; TNF-Related Apoptosis-Inducing Ligand - blood; TRAIL protein; Troponin; Tumor necrosis factor; Tumor necrosis factor-TNF; Czech Republic
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0053860

Apoptosis plays an important role in the development of heart failure. The aim of the prospectively designed study was to assess whether the concentration of apoptotic markers apoptosis-stimulating fragment (Fas, CD95/APO-1) and tumor necrosis factor-related apoptosis inducing ligand (TRAIL) can predict prognosis in patients with acute coronary syndromes. The concentrations of soluble Fas and TRAIL were determined in 295 patients with acute coronary syndromes. The status of all patients was evaluated at 6 months. The primary goal was a composite end-point of death and hospitalization for heart failure. The secondary end-points were re-MI, death alone and stroke alone. During the median follow-up of 6 months, 26 patients experienced the composite end-point. Using multivariate logistic regression, the concentration of TRAIL was the strongest significant and independent predictor of composite end-point (OR 0.11 (95% CI 0.03-0.45), p = 0.002). Low concentration was associated with poor prognosis of patients. Other significant predictors of composite end-point were serum creatinine (OR 7.7 (95% CI 1.1-54.5, p = 0.041) and complete revascularization (OR 0.19 (95% CI 0.05-0.78, p = 0.02). Independent significant predictors of death in the multivariate analysis were the concentration of TRAIL (OR 0.053 (95% CI 0.004-0.744), p = 0.029), older age (OR 1.20 (95% CI 1.02-1.41, p = 0.026) and serum creatinine (OR 15.1 (95% CI 1.56-145.2), p = 0.0193). Re-MI or stroke could not be predicted by any combination of obtained parameters. Low concentrations of soluble TRAIL represent a strong predictor of a poor prognosis in patients with acute coronary syndrome. The predictive value of TRAIL concentration is independent of age, ejection fraction, index peak troponin level, concentration of BNP or serum creatinine.