Prognostic impact of antiphospholipid antibodies in acute coronary syndrome
Y Ishii, H Mori, K Ishii, A Yamanouchi, T Miyata, H Kawasumi, M Kure, Y Numaziri, Y Tanizaki, Y Takei, K Tashiro, T Sato, H SuzukiAbstract
Background
Antiphospholipid syndrome (APS) promotes thrombogenicity through antiphospholipid antibodies, leading to thrombotic events in both venous and arterial systems. Although uncommon, acute coronary syndrome (ACS) can occur as a thrombotic manifestation of APS. However, the prevalence of antiphospholipid antibodies among patients with ACS and their association with clinical outcomes remain unclear.
Purpose
We aimed to assess the prevalence and prognostic impact of antiphospholipid antibodies in patients with ACS.
Methods
ACS patients (N=184) who underwent primary percutaneous coronary intervention (PCI) and blood testing for antiphospholipid antibodies at hospitalization were retrospectively enrolled between October 2022 and September 2024. Antiphospholipid antibodies included lupus anticoagulant (LA), anti-cardiolipin IgG (aCL-IgG), anti-cardiolipin IgM (aCL-IgM), and beta-2-glycoprotein I (β2GPI). Depending on whether at least one antibody was present, patients were divided into a ≥1 positive group (n=49) or a negative group (n=135), and clinical characteristics were compared. Major adverse cardiac events (MACE) were defined as cardiovascular death, nonfatal myocardial infarction, stroke, or ischemia-driven revascularization.
Results
Overall, LA, aCL-IgG, aCL-IgM, and β2GPI antibodies were positive in 23.4%, 3.3%, 1.1%, and 0% of patients, respectively. At least one antiphospholipid antibody was positive (≥1 positive) in 26.6% of patients. Clinical characteristics are shown in Table 1. Patients with ≥1 positive antibodies had a lower prevalence of hyperlipidemia and higher eGFR values, while there were no differences in ACS characteristics. Kaplan–Meier survival curves for MACE are shown in Figure 1. Patients with ≥1 positive antibodies showed significantly worse event-free survival than those with negative antibodies (HR 3.04, 95% CI:1.27-7.63, P=0.01).
Conclusion
The presence of antiphospholipid antibodies is associated with worse clinical outcomes in patients with ACS, beyond conventional coronary risk factors.Figure and table