Soluble urokinase plasminogen activator receptor as a long-term prognostic biomarker in acute coronary syndromes

<b>Purpose:</b> The aim of our study was to analyse the long-term prognostic value of soluble urokinase plasminogen activator receptor (suPAR) in the setting of an acute coronary syndrome (ACS). <b>Methods:</b> We included 340 patients with an ACS who underwent coronary angiography and plasma suPAR concentration was measured. Patients were classified into low suPAR concentrations (&lt;2.6 ng/mL) and high suPAR concentrations (≥2.6 ng/mL) and long-term events were evaluated. suPAR prognostic value was assessed beyond a clinical model that included age, GRACE score, estimated glomerular filtration rate, cardiac troponin-I peak and left ventricular ejection fraction &lt;40%. <b>Results:</b> Higher suPAR concentrations were associated with an increased prevalence of cardiovascular risk factors. After multivariate adjustment, suPAR ≥2.6 ng/mL were independently associated with an increased risk of all-cause death (HR 2.3; 95%CI 1.2–4.4; <i>p</i> = .017), major adverse cardiovascular events (MACE) (HR 1.7; 95%CI 1.1–2.5; <i>p</i> = .020) and heart failure (HR 4.1; 95%CI 1.3–12.6; <i>p</i> = .015), but not with myocardial infarction. For long-term all-cause death significant improvement of reclassification and discrimination were seen after addition of suPAR to a clinical model. <b>Conclusions:</b> In the setting of an ACS, suPAR is associated with long-term all-cause death, heart failure and MACE, and provides incremental prognostic value beyond traditional risks factors.

**研究目的：** 本研究旨在分析可溶性尿激酶型纤溶酶原激活物受体（suPAR）在急性冠状动脉综合征（ACS）患者中的长期预后价值。
**研究方法：** 本研究纳入340例确诊急性冠状动脉综合征并接受冠状动脉造影的患者，检测其血浆suPAR浓度。依据血浆suPAR浓度将患者划分为低浓度组（＜2.6 ng/mL）与高浓度组（≥2.6 ng/mL），并对患者的长期不良事件进行随访评估。本研究在纳入年龄、全球急性冠状动脉事件注册（GRACE）评分、估算肾小球滤过率、心肌肌钙蛋白-I峰值及左心室射血分数＜40%的临床预测模型基础上，进一步评估suPAR的预后增量价值。
**研究结果：** 较高的suPAR浓度与心血管危险因素的患病率升高显著相关。经多变量校正后，suPAR≥2.6 ng/mL与全因死亡风险升高独立相关（风险比HR=2.3，95%置信区间CI：1.2~4.4，P=0.017）、主要不良心血管事件（MACE）风险升高（HR=1.7，95%CI：1.1~2.5，P=0.020）以及心力衰竭风险升高（HR=4.1，95%CI：1.3~12.6，P=0.015），但与心肌梗死无显著关联。将suPAR加入上述临床预测模型后，患者长期全因死亡的风险重新分类及判别能力均得到显著改善。
**研究结论：** 在急性冠状动脉综合征患者中，suPAR与长期全因死亡、心力衰竭及主要不良心血管事件（MACE）显著相关，且相较于传统心血管危险因素，suPAR可提供额外的预后预测价值。