TCA cycle metabolites associated with adverse outcomes after acute coronary syndrome: Mediating effects of renal function

To examine relationships of tricarboxylic acid (TCA) cycle metabolites with risk of cardiovascular events and all-cause mortality in 309 patients with acute coronary syndrome (ACS), and determine whether these associations were modified by renal function. We found that higher plasma TCA cycle metabolites including isocitrate, aconitate and d/l-2-hydroxyglutarate were associated with risk of MACE and all-cause mortality in ACS patients. Furthermore, mediation analyses demonstrated that eGFR is a strong mediator of these associations.