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Thromb Haemost 2013; 109(04): 706-715
DOI: 10.1160/TH12-10-0714
Cardiovascular Biology and Cell Signalling
Schattauer GmbH

Serum levels of anti-apolipoprotein A-1 auto-antibodies and myeloperoxidase as predictors of major adverse cardiovascular events after carotid endarterectomy

Nicolas Vuilleumier   *
1   Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals, Geneva , Switzerland
2   Department of Human Protein Science, Geneva Faculty of Medicine, Geneva, Switzerland
,
Fabrizio Montecucco   *
3   Division of Cardiology Department of Internal Medicine, University of Geneva, Geneva, Switzerland
4   First Medical Clinic, Laboratory of Phagocyte Physiopathology and Inflammation, Department of Internal Medicine, University of Genoa, Genoa, Italy
,
Giovanni Spinella
5   Vascular and Endovascular Surgery Unit, Department of Surgery, San Martino Hospital, Genoa, Italy
,
Sabrina Pagano
1   Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals, Geneva , Switzerland
2   Department of Human Protein Science, Geneva Faculty of Medicine, Geneva, Switzerland
,
Maria Bertolotto
4   First Medical Clinic, Laboratory of Phagocyte Physiopathology and Inflammation, Department of Internal Medicine, University of Genoa, Genoa, Italy
,
Bianca Pane
5   Vascular and Endovascular Surgery Unit, Department of Surgery, San Martino Hospital, Genoa, Italy
,
Aldo Pende
4   First Medical Clinic, Laboratory of Phagocyte Physiopathology and Inflammation, Department of Internal Medicine, University of Genoa, Genoa, Italy
,
Katia Galan
3   Division of Cardiology Department of Internal Medicine, University of Geneva, Geneva, Switzerland
,
Pascale Roux-Lombard
1   Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals, Geneva , Switzerland
6   Division of Immunology and Allergy, Department of Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
,
Christophe Combescure
7   CRC & Division of clinical-epidemiology, Department of health and community medicine, University of Geneva & University Hospitals of Geneva, Geneva, Switzerland
,
Franco Dallegri
4   First Medical Clinic, Laboratory of Phagocyte Physiopathology and Inflammation, Department of Internal Medicine, University of Genoa, Genoa, Italy
,
François Mach   #
3   Division of Cardiology Department of Internal Medicine, University of Geneva, Geneva, Switzerland
,
Domenico Palombo   #
5   Vascular and Endovascular Surgery Unit, Department of Surgery, San Martino Hospital, Genoa, Italy
› Author Affiliations Financial support: This research was funded by EU FP7, Grant number 201668, AtheroRemo to Dr. F. Mach. This work was supported by Swiss National Science Foundation Grants to Dr N. Vuilleumier (# 310030_140736), to Dr. F. Mach (#310030_118245), to Dr. F. Montecucco (#32003B_134963/1). This work was supported by a grant from Novartis Foundation to Dr. F. Montecucco.
Further Information

Publication History

Received: 01 October 2012

Accepted after major revision: 06 January 2013

Publication Date:
22 November 2017 (online)

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Summary

We aimed at challenging the prognostic accuracies of myeloperoxidase (MPO) and antibodies anti-apolipoprotein A-1 (anti-apoA-1 IgG), alone or in combination, for major adverse cardiovascular events (MACE) prediction, one year after carotid endarterectomy (CEA). In this prospective single centre study, 178 patients undergoing elective CEA were included. Serum anti-apoA-1 IgG and MPO were assessed by enzyme-linked immunosorbent assay prior to the surgery. Post-hoc determination of the MPO cut-off was performed by receiver operating characteristics (ROC) analyses. MACE was defined by the occurrence of fatal or non-fatal acute coronary syndromes or stroke during one year follow-up. Prognostic accuracy of anti-apoA-1 IgG was assessed by ROC curve analyses, survival analyses and reclassification statistics. During follow-up, 5% (9/178) of patients presented a MACE, and 29% (52/178) were positive for anti-apoA-1 IgG. Patients with MACE had higher median MPO and anti-apoA-1 IgG levels at admission (p=0.01), but no difference for the 10-year global Framingham risk score (FRS) was observed (p=0.22). ROC analyses indicated that both MPO and anti-apoA-1 IgG were significant predictors of subsequent MACE (area under the curve [AUC]: 0.75, 95% confidence interval [95%CI]: 0.61–0.89, p=0.01; and 0.74, 95%CI: 0.59–90; p=0.01), but combining anti-apoA-1 IgG positivity and MPO>857 ng/ml displayed the best predictive accuracy (AUC: 0.78, 95%CI: 0.65–0.91; p=0.007). It was associated with a poorer MACE-free survival (98.2% vs. 57.1%; p<0.001, LogRank), with a positive likelihood ratio of 13.67, and provided incremental predictive ability over FRS. In conclusion, combining the assessment of anti-apoA-1 IgG and MPO appears as a promising risk stratification tool in patients with severe carotid stenosis.

Keywords

Autoantibodies - myeloperoxidase - atherosclerosis - major adverse cardiovascular events - carotid stenosis

* These authors equally contributed as first authors to this work.


# These authors equally contributed as last authors to this work.


 

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