PMID- 22687182
OWN - NLM
STAT- MEDLINE
DCOM- 20130311
LR  - 20240407
IS  - 1553-2712 (Electronic)
IS  - 1069-6563 (Print)
IS  - 1069-6563 (Linking)
VI  - 19
IP  - 6
DP  - 2012 Jun
TI  - Cholesteryl esters associated with acyl-CoA:cholesterol acyltransferase predict 
      coronary artery disease in patients with symptoms of acute coronary syndrome.
PG  - 673-82
LID - 10.1111/j.1553-2712.2012.01378.x [doi]
AB  - OBJECTIVES: Identifying the likelihood of a patient having coronary artery 
      disease (CAD) at the time of emergency department (ED) presentation with chest 
      pain could reduce the need for stress testing or coronary imaging after 
      myocardial infarction (MI) has been excluded. The authors aimed to determine if a 
      novel cardiac biomarker consisting of plasma cholesteryl ester (CE) levels 
      typically derived from the activity of the enzyme acyl-CoA:cholesterol 
      acyltransferase (ACAT2) are predictive of CAD in a clinical model. METHODS: A 
      single-center prospective cohort design enrolled participants with symptoms of 
      acute coronary syndrome (ACS) undergoing coronary computed tomography angiography 
      (CCTA) or invasive angiography. Plasma samples were analyzed for CE composition 
      with mass spectrometry. The primary endpoint was any CAD determined at 
      angiography. Multivariable logistic regression analyses were used to estimate the 
      relationship between the sum of the plasma concentrations from cholesteryl 
      palmitoleate (16:1) and cholesteryl oleate (18:1) (defined as ACAT2-CE) and the 
      presence of CAD. The added value of ACAT2-CE to the model was analyzed comparing 
      the C-statistics and integrated discrimination improvement (IDI). RESULTS: The 
      study cohort was composed of 113 participants with a mean (+/- standard deviation 
      [SD]) age of 49 (+/-11.7) years, 59% had CAD at angiography, and 23% had an MI 
      within 30 days. The median (interquartile range [IQR]) plasma concentration of 
      ACAT2-CE was 938 mumol/L (IQR = 758 to 1,099 mumol/L) in patients with CAD and 824 
      mumol/L (IQR = 683 to 998 mumol/L) in patients without CAD (p = 0.03). When 
      considered with age, sex, and the number of conventional CAD risk factors, 
      ACAT2-CE levels were associated with a 6.5% increased odds of having CAD per 10 
      mumol/L increase in concentration. The addition of ACAT2-CE significantly improved 
      the C-statistic (0.89 vs. 0.95, p = 0.0035) and IDI (0.15, p < 0.001) compared to 
      the reduced model. In the subgroup of low-risk observation unit patients, the CE 
      model had superior discrimination compared to the Diamond-Forrester 
      classification (IDI = 0.403, p < 0.001). CONCLUSIONS: Plasma levels of ACAT2-CE 
      have strong potential to predict a patient's likelihood of having CAD when 
      considered in a clinical model but not when used alone. In turn, a clinical model 
      containing ACAT2-CE could reduce the need for cardiac imaging after the exclusion 
      of MI.
CI  - (c) 2012 by the Society for Academic Emergency Medicine.
FAU - Miller, Chadwick D
AU  - Miller CD
AD  - Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, 
      NC, USA. cmiller@wfubmc.edu
FAU - Thomas, Michael J
AU  - Thomas MJ
FAU - Hiestand, Brian
AU  - Hiestand B
FAU - Samuel, Michael P
AU  - Samuel MP
FAU - Wilson, Martha D
AU  - Wilson MD
FAU - Sawyer, Janet
AU  - Sawyer J
FAU - Rudel, Lawrence L
AU  - Rudel LL
LA  - eng
GR  - P01 HL049373-19/HL/NHLBI NIH HHS/United States
GR  - 5 M01 RR07122-17/RR/NCRR NIH HHS/United States
GR  - HL-49373/HL/NHLBI NIH HHS/United States
GR  - M01 RR007122-19/RR/NCRR NIH HHS/United States
GR  - M01 RR007122/RR/NCRR NIH HHS/United States
GR  - P01 HL049373/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Acad Emerg Med
JT  - Academic emergency medicine : official journal of the Society for Academic 
      Emergency Medicine
JID - 9418450
RN  - 0 (Biomarkers)
RN  - EC 2.3.1.26 (Sterol O-Acyltransferase)
SB  - IM
MH  - Acute Coronary Syndrome/blood/complications/*diagnosis
MH  - Adult
MH  - Biomarkers/blood
MH  - Chest Pain/*etiology
MH  - Coronary Angiography
MH  - Coronary Artery Disease/blood/complications/*diagnosis
MH  - Emergency Service, Hospital
MH  - Female
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Mass Spectrometry
MH  - Middle Aged
MH  - Prospective Studies
MH  - Sterol O-Acyltransferase/*blood
MH  - Tomography, X-Ray Computed
PMC - PMC3566778
MID - NIHMS368600
EDAT- 2012/06/13 06:00
MHDA- 2013/03/12 06:00
PMCR- 2013/06/01
CRDT- 2012/06/13 06:00
PHST- 2012/06/13 06:00 [entrez]
PHST- 2012/06/13 06:00 [pubmed]
PHST- 2013/03/12 06:00 [medline]
PHST- 2013/06/01 00:00 [pmc-release]
AID - 10.1111/j.1553-2712.2012.01378.x [doi]
PST - ppublish
SO  - Acad Emerg Med. 2012 Jun;19(6):673-82. doi: 10.1111/j.1553-2712.2012.01378.x.