Circulating β-hydroxybutyrate levels are associated with major adverse clinical events in patients with acute myocardial infarction

Background and aims: Acute myocardial infarction is associated with high mortality, and effective biomarkers are required for the risk stratification. In cardiovascular diseases, circulating levels of ketone bodies (KB) such as beta-hydroxybutyrate (beta-OHB) and acetoacetate are altered. However, the relationship between circulating KB levels and major adverse clinical events (MACE) in patients with ST-elevation myocardial infarction (STEMI) is unknown. Methods and results: Patients with STEMI undergoing percutaneous coronary intervention (PCI) between January 2010 to June 2020 were enrolled, and divided into T1 (<0.09 mmol/L, n = 219), T2 (0.09-0.28 mmol/L, n = 202), and T3 (>0.28 mmol/L, n = 211) tertiles according to the circulating beta-OHB levels within 24 h of admission. The primary endpoint was in-hospital MACE. The incidence of in-hospital MACE in the T3 group (20.9 %) was significantly higher than in the T1 group (10.5 %) and T2 group (14.9 %) (P = 0.012). Multivariate logistic regression analysis showed that elevated circulating beta-OHB levels were associated with an increased risk of all-cause mortality and MACE during hospitalization (OR = 1.38, 95 % CI = 1.08-1.77, P = 0.009). During follow-up period, multivariate Cox regression analyses showed that elevated circulating beta-OHB levels were associated with higher all-cause mortality and MACE (HR = 1.35, 95 % CI = 1.17-1.56, P < 0.001). The impact of beta-OHB on MACE were similar for all the subgroups. Conclusion: Elevated circulating beta-OHB levels within 24 h of admission were associated with an increased risk of MACE in patients with STEMI undergoing PCI, and could be a promising prognosis biomarker.