Level of circulating phospholipase A2 in prediction of the prognosis of patients with suspected myocardial infarction.

Objectives. Atherosclerotic lesions result from inflammatory-proliferative responses of the endothelium and smooth muscle of the arterial wall. Poor prognosis of acute myocardial infarction (AMI) patients has been associated with elevated levels of acute phase proteins including C-reactive protein. We investigated the significance of circulating phospholipase A2 in the long-term prognosis of suspected AMI patients. Methods. The concentration of phospholipase A2 was measured by an immunoassay in sera of 100 suspected AMI patients. Admission phospholipase A2 95% fractile outliers were excluded to eliminate the effect of acute infectious diseases. The total and atherosclerotic mortalities were followed for a 4-year period. Results. The most powerful prognostic limit for both admission (p=0.02, RR=2.6 and 95% CI=1.2 to 5.6) and maximal (p=0.06, RR=2.4 and 95% CI=0.96 to 5.9) phospholipase A2 groups was ≥ 8 μg/l. The admission phospholipase A2 level had an independent prognostic significance for atherosclerotic mortaligy (p=0.04, RR=2.4 and CI=1.02 to 5.8) in multivariate analysis with CK-MB and age. Conclusions. The eleated serum phospholipase A2 level at admission is an independent predictor of long-term atherosclerotic mortality in patients with suspected AMI. The prognostic significance of phospholipase A2 weakens during hospitalisation concomitant to the onset of the acute inflammatory response to myocardial injury.