CLINICAL STUDIES
Serum amyloid A predicts early mortality in acute coronary syndromes: a TIMI 11A substudy
David A. Morrow, MD*,
Nader Rifai, PhD ,
Elliott M. Antman, MD, FACC*,
Debra L. Weiner, MD, PhD,
Carolyn H. McCabe, BS*,
Christopher P. Cannon, MD, FACC* and
Eugene Braunwald, MD, FACC*
* Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
Department of Laboratory Medicine, Children’s Hospital, Boston, Massachusetts, USA
Manuscript received June 7, 1999;
revised manuscript received September 20, 1999,
accepted October 27, 1999.
Reprint requests and correspondence: Dr. David A. Morrow, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis Street, Boston, Massachusetts 02115
damorrow{at}bics.bwh.harvard.edu
OBJECTIVES
We evaluated the ability of serum amyloid A (SAA), alone and in combination with a rapid qualitative assay for cardiac-specific troponin T (cTnT), to predict 14-day mortality in patients with unstable angina or non-Q wave myocardial infarction (NQMI).
BACKGROUND
Elevated C-reactive protein (CRP) has been associated with adverse outcomes in unstable coronary syndromes but data regarding its acute phase counterpart, SAA, are conflicting.
METHODS
Serum amyloid A measurement and a rapid cTnT assay were performed on blood obtained at enrollment into Thrombolysis in Myocardial Infarction 11A, a dose-ranging trial of enoxaparin for unstable angina and NQMI.
RESULTS
Serum amyloid A was higher in patients who died compared with survivors (6.28 vs. 0.75 mg/dL, p = 0.002). Among patients with a negative rapid cTnT, mortality was higher for those in the top quintile of SAA (6.1 vs. 0.7%, p = 0.003). Patients with both an early positive rapid cTnT ( 10 min until assay positive) and SAA in the fifth quintile had the highest mortality followed by those with either markedly elevated SAA or an early positive rapid cTnT, while patients with both a negative rapid cTnT and SAA in quintiles 1–4 were at very low risk, (9.1 vs. 3.6 vs. 0.7%, p <0.002).
CONCLUSIONS
Similar to CRP, baseline elevation of SAA identifies patients hospitalized with unstable angina and NQMI at higher risk for early mortality, even among those with a negative rapid assay for cTnT. These data support further investigation of inflammatory markers used alone and in combination with cardiac troponins for risk assessment in unstable coronary syndromes.
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Abbreviations and Acronyms
| | CABG | = coronary artery bypass surgery | | CAD | = coronary artery disease | | cTnT | = cardiac specific troponin T | | MI | = myocardial infarction | | NQMI | = non-Q wave myocardial infarction | | SAA | = serum amyloid A | | TIMI | = Thrombolysis in Myocardial Infarction |
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