Mast cells and acute coronary syndromes: relationship between serum tryptase, clinical outcome and severity of coronary artery disease

Abstract

ObjectiveTo assess the relationship between serum tryptase and the occurrence of major cardiovascular and cerebrovascular events (MACCE) at 2-year follow-up in patients admitted with acute coronary syndrome (ACS). To compare serum tryptase to other validated prognostic markers (maximum high-sensitivity troponin (hs-Tn), C reactive protein (CRP) levels at admission, Synergy between percutaneous coronary intervention with Taxus and Cardiac Surgery (SYNTAX) score).MethodsWe measured serum tryptase at admission in 140 consecutive patients with ACS and in 50 healthy controls. The patients’ follow-up was maintained for 2 years after discharge. The predictive accuracy of serum tryptase for 2-year MACCE was assessed and compared with hs-Tn, CRP and SYNTAX score.ResultsSerum tryptase levels at admission were significantly higher in patients with ACS compared with the control group (p=0.0351). 2 years after discharge, 28/140 patients (20%) experienced MACCE. Serum tryptase levels, maximum hs-Tn measurements and SYNTAX score were higher in patients who experienced MACCE compared with those without (p<0.0001). Conversely, we found no significant association between MACCE and CRP. The predictive accuracy of serum tryptase for MACCE was set at the cut-off point of 6.7 ng/mL (sensitivity 46%, specificity 84%).ConclusionsIn patients with ACS, serum tryptase measured during index admission is significantly correlated to the development of MACCE up to 2 years, demonstrating a possible long-term prognostic role of this biomarker.

Paired acute‐baseline serum tryptase levels in perioperative anaphylaxis: An observational study

“…Issues related to specificity likely include the small increases in sAT concentrations occurring with random variations or nonanaphylactic events, and mechanisms of anaphylaxis that do not involve MC degranulation . Indeed, MC activation has been reported in atherosclerosis‐related cardiovascular events, coagulation abnormalities, and response to infectious agents . In line with previous cohorts, our results confirm that the consensus algorithm sAT >([1.2 × sBT] + 2) μg/L is a good compromise between empirical thresholds such as >(1.35 × sBT), which privileged sensitivity as high as 0.91 in previous literature and 0.81 in our study, or (sBT + 3) μg/L, which resulted in sensitivity values as low as 0.63 in the literature and 0.72 in our hands.…”

Elevated Serum Tryptase in Non-Anaphylaxis Cases: A Concise Review

“…In patients who had an ST segment elevation myocardial infarction, post percutaneous intervention tryptase negatively correlated with myocardial reperfusion and left ventricular ejection fraction [61]. Hence, patients who experienced major adverse cardiovascular events 2 years post ACS had higher baseline and discharged tryptase levels than those who did not [62,63]. This finding was independent of troponin and C-reactive protein levels [63].…”

Basal Tryptase Levels Can Predict Clinical Severity in Hymenoptera Venom Anaphylaxis and Ischemic Cardiovascular Disorders

“…Spikes in tryptase titers can be considered a marker of anaphylaxis [1,2], whereas increments in basal serum tryptase (BST) levels can be considered a marker of increased mast cell burden, as in mastocytosis [3], or of circumscribed inflammation, as in coronary atherosclerosis. In the follow-up of patients with previous acute coronary syndrome (ACS), we found that persisting elevated BST levels correlated with an increased risk of major adverse cardiovascular events (MACE) [4,5]. In other cases, high BST levels were shown to be biomarkers for the risk of severe allergic reactions to hymenoptera venom [6].…”

“…One population comprised patients with hymenoptera venom allergy (HVA) and a history of Mueller grade III and IV anaphylactic reactions [7]. The second population comprised patients with a history of ACS that we had previously described in 2 studies and now includes 9 new patients [8,5]. The statistical evaluation was based on a descriptive analysis, followed by inference using the Fisher exact test for categorical variables.…”

“…We performed a retrospective post hoc analysis of the efficacy and safety of a SIT study previously carried out by our group [4,5] with currently available HDM-based CRD. Our previous study was a prospective, phase 4, randomized, controlled study with a 5-year follow-up period.…”