Predictive value of elevated soluble CD40 ligand in patients undergoing primary angioplasty for ST-segment elevation myocardial infarction

Objectives The aim of this study was to evaluate the prognostic value of soluble CD40 ligand (sCD40L) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing a primary percutaneous coronary intervention (PCI). Background The prognostic value of sCD40L has been documented in patients with acute coronary syndrome; however, its value in acute STEMI remains unclear. Materials and methods We prospectively enrolled 499 consecutive STEMI patients (397 men, 102 women) undergoing primary PCI. The study population was divided into tertiles on the basis of admission sCD40L values. The high sCD40L group (n= 168) included patients with a value in the third tertile (>= 0.947 mg/l) and the low sCD40L group (n= 331) included patients with a value in the lower two tertiles (< 0.947 mg/l). Clinical characteristics and in-hospital and 1-year primary PCI outcomes were analyzed. Results The patients in the high sCD40L group were older (mean age 57.3 +/- 12.7 vs. 54.8 +/- 11.9, P=0.029). Higher in-hospital and 1-year all-cause mortality rates were observed in the high sCD40L group (7.7 vs. 3.3%, P= 0.029; 16.1 vs. 4.8%, P< 0.001, respectively). The results of Cox multivariate analysis indicated that a high sCD40L value at admission (> 0.947 mg/l) is a powerful independent predictor of 1-year all-cause mortality (odds ratio: 3.68; 95% confidence interval: 1.54-8.77; P= 0.003). Conclusion The results of this study suggest that a high sCD40L level at admission is associated with increased in-hospital and 1-year all-cause mortality rates in patients with STEMI undergoing primary PCI. Coron Artery Dis 25: 558-564 (C) 2014 Wolters Kluwer Health broken vertical bar Lippincott Williams & Wilkins.