Thrombospondin-1 plasma levels associated with in-hospital major adverse cardiovascular events in patients with acute coronary syndrome
Introduction
Cardiovascular disease, surpassing malignancy and communicable diseases, has become the leading cause of morbidity and mortality in most of the developed and developing countries in the past decades [1]. Acute coronary syndrome (ACS), one of the most severe emergencies of cardiovascular disease, describes the range of myocardial ischemic states, including unstable angina (UA), non-ST-elevation myocardial infarction (NSTEMI), or ST-elevation myocardial infarction (STEMI). Although the interventional and drug therapies have been greatly improved and optimized, the ACS remains a heavy burden on society due to the aging population [2]. Thus, the mechanisms, intervention targets, and valuable biomarkers of ACS are under intensive focus.
Thrombospondin-1 (TSP-1) was first reported in 1972 and recognized as a novel component of platelets [3]. TSP-1, possessing multiple domains, determines its broad interaction with diverse types of cells via binding to integrins, CD47, CD36, low-density lipoprotein 1, and other cell surface receptors [4]. Based on the sophisticated crosstalk with different cells, TSP-1 was confirmed to exert the proinflammatory effect, anti-angiogenesis, platelet macroaggregates, vascular tone, and tumor progression [5]. The role of TSP-1 in cardiovascular health and pathology is complex, and the underlying mechanisms are not yet clarified [6]. Briefly, TSP-1 plays a key role in thrombosis formation, matrix remodeling, endothelial dysfunction, angiogenesis, and apoptosis. Some clinical studies also verified the association of TSP-1 with cardiovascular diseases [7,8].
Although the elevated TSP-1 plasma levels in STEMI have been reported previously, its concentration in UA and NSTEMI, the two critical elements of ACS, are yet to be elucidated [9]. Moreover, the correlation between the plasma TSP-1 levels and in-hospital prognosis in patients with ACS has not been identified. Thus, the present study was designed to identify the association between TSP-1 and in-hospital major adverse cardiovascular events (MACEs) in patients with ACS. We present the following article in accordance with the STROBE reporting checklist.
Section snippets
Study populations and study design
The cross-sectional study was conducted in heart centre of Beijing Chaoyang Hospital. Patients with ACS were recruited from May 2021 to November 2021. The ACS and its subtypes were diagnosed according to the guidelines for the management of patients with ACS [10,11]. Briefly, the typical symptoms of myocardial ischemia, abnormal electrocardiogram, and elevated myocardial enzymes were considered during the diagnosis. The absence of persistent ST-elevation is suggestive of NSTE-ACS. If cardiac
Results
A total of 360 patients with the clinical diagnosis of ACS were screened, and 7 patients were excluded due to the normal or mild stenosis (<50%) in coronary angiography. In addition, 12 patients who met the other exclusion criteria were also excluded during the screening. Finally, 341 patients (including 156 patients with UA, 91 patients with NSTEMI, and 94 patients with STEMI) were recruited (Fig. 1).
Discussion
This study focus on the TSP-1 plasma levels in the ACS population, and the correlation between the TSP-1 plasma levels and the in-hospital MACEs was explored. The data revealed that the TSP-1 plasma levels in patients with acute MI (STEMI and NSTEMI) were significantly higher than in patients with UA. We also found that the TSP-1 plasma levels were positively associated with inflammatory markers, myocardial necrosis biomarkers, and BNP in the ACS population. The major finding is that the TSP-1
Limitations
The present study has several limitations. First, this is a cross-sectional study conducted in a single center with a low evidence-based level. Second, the small sample size reduces the reliability of the conclusion. Another limitation is that the association between TSP-1 plasma level and MACE is not associated causally. This endpoint heterogeneity may confound the results obtained for the biomarker. We performed a sensitivity analysis and confirmed the consistent associations between the
Conclusion
TSP-1 plasma levels were higher in patients with NSTEMI and STEMI compared to those in UA. The correlation between TSP-1 plasma levels and other established prognostic factors make it a novel correlative element of ACS for in-hospital prognosis.
The following are the supplementary data related to this article.
Funding
None.
Declaration of Competing Interest
The authors have no conflicts of interest to declare.
Acknowledgments
We would like to acknowledge the help and support of our colleagues. We would also like to thank Dr. XG Yu for reviewing the manuscript.
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