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.