Rationale: In contrast to cardiomyocyte necrosis, which can be quantified by cardiac troponin, functional cardiomyocyte impairment, including mitochondrial dysfunction, has escaped clinical recognition in acute myocardial infarction (AMI) patients. Objective: To investigate the diagnostic accuracy for AMI and prognostic prediction of in-hospital mortality of cytochrome c. Methods and Results: We prospectively assessed cytochrome c serum levels at hospital presentation in 2 cohorts: a diagnostic cohort of patients presenting with suspected AMI and a prognostic cohort of definite AMI patients. Diagnostic accuracy for AMI was the primary diagnostic end point, and prognostic prediction of in-hospital mortality was the primary prognostic end point. Serum cytochrome c had no diagnostic utility for AMI (area under the receiver-operating characteristics curve 0.51; 95% confidence intervals 0.44-0.58; P=0.76). Among 753 AMI patients in the prognostic cohort, cytochrome c was detectable in 280 (37%) patients. These patients had higher in-hospital mortality than patients with nondetectable cytochrome c (6% versus 1%; P<0.001). This result was mainly driven by the high mortality rate observed in ST-segment-elevation AMI patients with detectable cytochrome c, as compared with those with nondetectable cytochrome c (11% versus 1%; P<0.001). At multivariable analysis, cytochrome c remained a significant independent predictor of in-hospital mortality (odds ratio 3.0; 95% confidence interval 1.9-5.7; P<0.001), even after adjustment for major clinical confounders (odds ratio 4.01; 95% confidence interval 1.20-13.38; P=0.02). Conclusions: Cytochrome c serum concentrations do not have diagnostic but substantial prognostic utility in AMI.
Diagnostic and Prognostic Utility of Circulating Cytochrome c in Acute Myocardial Infarction / G. Marenzi, N. Cosentino, J. Boeddinghaus, M. Trinei, M.G. Delazzo, V. Milazzo, M. Moltrasio, D. Cardinale, M.T. Sandri, F. Veglia, A. Bonomi, M. Kaech, R. Twerenbold, T. Nestelberger, T. Reichlin, K. Wildi, S. Shrestha, N. Kohzuharov, Z. Sabti, C.M. Cipolla, C. Mueller, A.L. Bartorelli. - In: CIRCULATION RESEARCH. - ISSN 0009-7330. - 119:12(2016), pp. 1339-1346.
|Titolo:||Diagnostic and Prognostic Utility of Circulating Cytochrome c in Acute Myocardial Infarction|
|Parole Chiave:||acute myocardial infarction; cardiac troponin; cytochrome c; mitochondrial dysfunction; prognosis|
|Settore Scientifico Disciplinare:||Settore MED/11 - Malattie dell'Apparato Cardiovascolare|
|Data di pubblicazione:||2016|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1161/CIRCRESAHA.116.309792|
|Appare nelle tipologie:||01 - Articolo su periodico|