334 AMYLOID-BETA 1-40 AND DAPT IN ACUTE MYOCARDIAL INFARCTION. (15th December 2022) - Aleksova, Aneta
Abstract: Background: Atherosclerotic plaque destabilization and platelet activation is a prompt and progressive process that is the basis of acute coronary syndromes (ACS). Amyloid-β 1-40 (Aβ (1-40)), is highly expressed in atherosclerotic plaques and is released in plasma by activated platelets. Some animal studies suggested that an increase in amyloid precursor protein (sAPP770) levels upon atherosclerotic plaque activation, anticipates myocardial injury. Platelets inhibition is the keystone in the management of patients with ACS, but the data regarding the benefits of Dual Antiplatelet Therapy (DAPT) before coronary angiography is still disputed. Methods: In a large prospective cohort of 1038 patients hospitalized for AMI (both STEMI 702 /NSTEMI 333 patients), we evaluated the impact of DAPT on Aβ (1-40) levels, the correlation with inflammatory biomarkers, and Aβ (1-40) prognostic value on long-term mortality. Results: The median concentration of Aβ (1-40) in plasma at admission was 90.47 (54.49-130.47) pg/ml. At hospital admission patients on DAPT had significantly lower levels of Aβ (1-40) compared to patients receiving only aspirin (67.56 (42.7-120.23) pg/ml vs. 92.25 (56.16-131.17) pg/ml, p=0.004), independently of patients' gender or diagnosis STEMI/NSTEMI. Aβ (1-40) positively correlated with older age and higher levels of CRP and TNFα. There was no significant difference among patients who received DAPT therapy and those who did not towards age, presence of chronic renal failure, hypertension, nor in the rate of revascularization procedures (both percutaneous coronary intervention and bypass). Kaplan-Meier analysis showed that higher Aβ ​​(1-40) levels during the 49-month follow-up were associated with higher mortality risk (p<0.0001). Also, at multivariate Cox regression analysis Aβ ​​(1-40) level (HR =1.003 (95% CI, 1.001-1.005), p=0.017 was predictive for mortality, together with older age, higher interleukin (Il)-1β, worse left ventricular systolic function, and GFR ≤ 60 mL/min. Conclusions: STEMI/NSTEMI patients receiving DAPT at hospital admission, have a significantly lower plasma concentration of Aβ (1-40), which is an independent predictor of long-term mortality.