Association Between Anticardiolipin Antibodies and Recurrent Cardiac Events in Patients With Acute Coronary Syndrome

Abstract

SUMMARYTo determine whether the presence of anticardiolipin (aCL) antibodies in patients with acute coronary syndome is predictive of recurrent cardiac events in hospital stay and follow-up.The study population consisted of 80 patients with acute coronary syndrome. IgM and IgG aCL levels were determined before hospital discharge. We divided the patients into those with an aCL IgG ≥ 40 IgG phospholipid units (group I, n = 30) and those with an aCL IgG < 40 IgG phospholipid units (group II, n = 50). All patients underwent coronary angiography. Follow-up coronary angiography was performed 12 months after percutaneous coronary intervention (PCI). Infectious and autoimmune diseases were exclusion criteria. Patients were observed to determine overall mortality, reinfarction, and restenosis.There were no differences between the groups with respect to the prevalence of hypertension, diabetes mellitus, and cigarette smoking, sex, or ejection fraction. The prevalence of left ventricular thrombus was similar between the groups (group I: 16% versus group II: 16.7%, P > 0.05). Although the presence of left atrial thrombus was much more frequent in cardiolipin positive patients (13% versus 4%, respectively), the difference was not statistically significant (P = 0.19). Restenosis was observed in 40% of the cardiolipin positive patients and 14% of the cardiolipin negative patients (P < 0.01). There was no significant association between reinfarction and anticardiolipin positivity during followup (26% versus 10%, P > 0.05). In group I patients, in-hospital mortality was somewhat more frequent compared to group II patients (4% versus 10%), but the difference was not statistically significant (P = 0.27). One year mortality was similar between the groups.These results suggest that 1) restenosis occurs more frequently in anticardiolipin positive patients and 2) no association is evident between positive aCL and mortality, reinfarction, and intracardiac thrombus. (Int Heart J 2005; 46: 631-638)

Impact of Antiphospholipid Syndrome and/or Systemic Lupus Erythematosus on the Long-term Adverse Cardiovascular Outcomes in Patients After Percutaneous Coronary Intervention

“…A strong association between the levels of aCL antibodies and the outcomes of PCI after an ACS has also been observed. 8 …”

Cardiovascular Involvement in Autoimmune Diseases

“…Thus, ACLA promote AT by attracting monocytes into the vessel wall and inducing monocyte adherence to endothelial cells. All of this is mediated by adhesion molecules such as ICAM-1, VCAM-1, and E-selectin [7, 92]. The APLA should be considered more than an AT marker since they can enhance AT and are proatherogenic [93, 94].…”

Long-Term Outcome of Patients with Antiphospholipid Syndrome Who Undergo Percutaneous Coronary Intervention

“…Gürlek et al [18] reported a strong association between the levels of anticardiolipin antibodies and the outcome of PCI after an ACS. In this study, higher levels of anticardiolipin antibodies predicted increased rates of restenosis after PCI, without an effect on mortality.…”

“…In particular, there is a paucity of data regarding the outcome of patients with APS who undergo coronary revascularization. Small studies have demonstrated that patients with APS are predisposed to high rates of restenosis of the coronary arteries and vascular grafts after percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery, respectively, causing significant morbidity and mortality [16,17,18,19]. Some of these studies were conducted more than a decade ago, in the percutaneous transluminal coronary angioplasty era, and are therefore less relevant for contemporary PCI practice [16,19].…”