Abstract:

Objective To investigate the clinical role of a disintegrin and metalloproteinase with thrombospondin motif 13（ADAMTS-13）in identifying high-risk non-ST-segment elevation myocardial infarction（NSTEMI）. Methods ADAMTS-13 activity determination was performed on the samples collected from 142 patients with NSTEMI（NSTEMI group） through a fluorescence resonance energy transfer（FRET）-based assay. Totally,50 non-coronary heart disease patients with normal coronary angiography were enrolled as control group during the same period. The baseline information,clinical data and determination results [creatinine（Cr）,high-sensitivity cardiac troponin I（hs-cTnI）,platelet（PLT） count,D-dimer（DD）] were collected. According to the Global Registry of Acute Coronary Events（GRACE）score at admission,the NSTEMI patients were classified into low-risk group（43 cases）,medium-risk group（54 cases）and high-risk group（45 cases）. Spearman rank correlation analysis was used to analyze the correlation between ADAMTS-13 activity and risk stratification in NSTEMI patients. Binary Logistic regression analysis was used to investigate the influencing factors for high-risk NSTEMI. Receiver operating characteristic（ROC）curve was used to evaluate the clinical value of ADAMTS-13 on high-risk NSTEMI. Results The ADAMTS-13 activity in NSTEMI group was lower than that in control group（P<0.001）,and it was decreased from low-risk,medium-risk to high-risk groups（P<0.01）. Spearman rank correlation analysis results showed that,ADAMTS-13 activity was negatively correlated with risk stratification in NSTEMI patients（r_s=-0.527,P<0.001 ）. Binary Logistic regression analysis showed that ADAMTS-13 was a protective factor [odds ratio（OR）=0.936,95% confidence interval（CI） 0.898-0.975]. Age,heart rate,Cr and Killip grading ≥Ⅱ were risk factors（OR=1.148,1.085,1.023 and 26.207,95%CI 1.047-1.259,1.023-1.150,1.004-1.041 and 5.489-125.136）. ROC curve analysis indicated that the area under curve（AUC） of ADAMTS-13 activity in predicting high-risk NSTEMI was 0.784. When the optimal cut-off value was 61.7%,the sensitivity and specificity were 71.1% and 81.4%,respectively. Conclusions ADAMTS-13 activity is related to the risk stratification of NSTEMI,which has clinical value in the diagnosis of high-risk NSTEMI.

Key words: A disintegrin and metalloproteinase with thrombospondin motif 13, Non-ST-segment elevation myocardial infarction, High-risk, Global Registry of Acute Coronary Events