Coronary Artery Disease
Usefulness of Circulating Decoy Receptor 3 in Predicting Coronary Artery Disease Severity and Future Major Adverse Cardiovascular Events in Patients With Multivessel Coronary Artery Disease

https://doi.org/10.1016/j.amjcard.2015.06.041Get rights and content

Decoy receptor 3 (DcR3), a member of the tumor necrosis factor receptor superfamily, is an antiapoptotic soluble receptor considered to play an important role in immune modulation and has pro-inflammatory functions. This study was designed to test whether circulating DcR3 levels are associated with coronary artery disease (CAD) severity and predict future major adverse cardiovascular events (MACEs) in patients with CAD. Circulating DcR3 levels and the Syntax score (SXscore) were determined in patients with multivessel CAD. The primary end point was the MACE within 12 months. In total, 152 consecutive patients with angiographically confirmed multivessel CAD who had received percutaneous coronary intervention were enrolled and were divided into 3 groups according to CAD lesion severity. Group 1 was defined as low SXscore (≤13), group 2 as intermediate SXscore (>13 and ≤22), and group 3 as high SXscore (>22). DcR3 levels were significantly higher in the high SXscore group than the other 2 groups (13,602 ± 7,256 vs 8,025 ± 7,789 vs 4,637 ± 4,403 pg/ml, p <0.001). By multivariate analysis, circulating DcR3 levels were identified as an independent predictor for high SXscore (adjusted odds ratio 1.15, 95% confidence interval 1.09 to 1.21; p <0.001). The Kaplan-Meier analysis showed that increased circulating DcR3 levels are associated with enhanced 1-year MACE in patients with multivessel CAD (log-rank p <0.001). In conclusion, increased circulating DcR3 levels are associated with CAD severity and predict future MACE in patients with multivessel CAD.

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Methods

This study enrolled consecutive patients who were admitted to a tertiary medical referral center for PCI from 2012 to June 2013, with stable CAD and angiographically confirmed multivessel disease, defined as stenosis of ≥50% in ≥2 major epicardial vessels involving ≥2 separate coronary artery territories. Before enrollment, a detailed review of each patient's chart was conducted to gather data on medications, smoking status, and risk factors for CAD, such as age, hypertension, diabetes mellitus

Results

During a 12-month follow-up period to June 2014, 152 patients (110 men and 42 women; mean age 72.5 ± 11.7 years) were enrolled for analysis. Based on coronary angiography, 83 patients had 2-vessel CAD, 69 patients had 3-vessel CAD, and 23 patients were found to have left main disease (the presence of ≥50% stenosis in left main coronary artery).

All study subjects were divided into 3 groups (Table 1). Group 1 was defined as high SXscore (>22), group 2 as intermediate SXscore (>13 and ≤22), and

Discussion

In this study, we elucidate the relation between circulating DcR3 levels and CAD severity and DcR3 as a prognostic factor for patients with advanced atherosclerotic CAD. To the best of our knowledge, this is the first study to address how the increased serum DcR3 levels in patients with stable multivessel CAD who underwent PCI are associated with the severity of CAD determined by SXscore and the occurrence of 1-year MACE in a longitudinal follow-up data set. These findings provide novel

Disclosures

The authors have no conflicts of interest to disclose.

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    Drs Chang and Hsu contributed equally and both are first authors of this work.

    This study was supported, in part, by the following research grants: VGH-V103A-009, VGH-V102B-016 and VGH-V102E2-002 from the Taipei Veterans General Hospital (Taipei City, Taiwan) and a grant from the Taipei Veterans General Hospital-National Yang-Ming University-Excellent Physician Scientists Cultivation Program (Taipei City, Taiwan), No.103-V-B-049. Funding agencies had no role in study design, data collection, analysis, decision to publish, or preparation of the manuscript.

    See page 1032 for disclosure information.

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