Prognostic Utility of Soluble TREM-1 in Predicting Mortality and Cardiovascular Events in Patients With Acute Myocardial Infarction.

ABSTRACT

BACKGROUND: Triggering receptor expressed on myeloid cells-1 (TREM-1) is thought to be critical for inflammatory signal amplification and involved in the development of atherosclerosis. TREM-1 is significantly increased in patients with myocardial infarction. The aim of this study was to investigate the association between soluble TREM-1 (sTREM-1) and mortality and cardiovascular events in patients with acute myocardial infarction. METHODS AND RESULTS: We included 838 consecutive patients with acute myocardial infarction from October 7, 2012 to December 5, 2014. Blood samples were collected from patients with acute myocardial infarction immediately after diagnosis. During follow-up, 88 patients died, and 180 patients reached the combined end points of major adverse cardiovascular event (MACE). Patients with high sTREM-1 (higher than the median) had increased risk of all-cause mortality and MACE compared with those with low sTREM-1 (log-rank test, P<0.001). After adjustment for confounding risk factors by Cox regression analysis, high sTREM-1 remained an independent predictor of all-cause mortality (hazard ratio, 1.978; 95% confidence interval, 1.462-2.675; P<0.001) and MACE (hazard ratio, 2.413; 95% confidence interval, 2.022-2.879; P<0.001). After the addition of sTREM-1 to the reference model, the C-statistic for all-cause mortality increased from 0.86 to 0.89, and the difference was 0.023 (95% confidence interval, 0.0009-0.0477), and the C-statistic for MACE increased from 0.71 to 0.80, and the difference was 0.087 (95% confidence interval, 0.053-0.122). sTREM-1 levels were consistently positively associated with risks of all-cause mortality and MACE in various subpopulations, and there was no significant interaction among prespecified subgroups. CONCLUSIONS: sTREM-1 was significantly associated with all-cause mortality and MACE, independent of established conventional risk factors in patients with acute myocardial infarction.