4.7 Article

Prognostic value of gut microbiota-derived metabolites in patients with ST-segment elevation myocardial infarction

Journal

AMERICAN JOURNAL OF CLINICAL NUTRITION
Volume 117, Issue 3, Pages 499-508

Publisher

ELSEVIER SCIENCE INC
DOI: 10.1016/j.ajcnut.2022.12.013

Keywords

gut microbiota-derived metabolites; the Synergy between percutaneous coronary intervention with Taxus and cardiac surgery score; Gensini score; Balloon pump-assisted Coronary Intervention Study jeopardy score; ST-segment elevation myocardial infarction

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This study found that plasma levels of certain gut microbiota-derived metabolites are associated with major adverse cardiovascular events (MACEs) in patients with ST-segment elevation myocardial infarction (STEMI). Higher levels of PAGln, IS, DCA, TML, and TMAO are significantly correlated with MACEs, suggesting that these metabolites may serve as useful prognostic markers for STEMI patients.
Background: Studies about the prognostic role of gut microbiota-derived metabolites including phenylacetyl glutamine (PAGln), indoxyl sulfate (IS), lithocholic acid (LCA), deoxycholic acid (DCA), trimethylamine (TMA), trimethylamine N-oxide (TMAO), and its precursor trimethyllysine (TML) are limited in patients with ST-segment elevation myocardial infarction (STEMI).Objectives: To examine the relationship between plasma metabolite levels and major adverse cardiovascular events (MACEs), including nonfatal MI, nonfatal stroke, all-cause mortality, and heart failure in patients with STEMI.Methods: We enrolled 1004 patients with STEMI undergoing percutaneous coronary intervention (PCI). Plasma levels of these metabolites were determined by targeted liquid chromatography/mass spectrometry. The associations of metabolite levels with MACEs were assessed with the Cox regression model and quantile g-computation.Results: During a median follow-up of 360 d, 102 patients experienced MACEs. Higher plasma PAGln (hazard ratio [HR], 3.17 [95% CI: 2.05, 4.89]; P < 0.001), IS (2.67 [1.68, 4.24], P < 0.001), DCA (2.36 [1.40, 4.00], P 1/4 0.001), TML (2.66 [1.77,3.99], P < 0.001), and TMAO (2.61 [1.70, 4.00], P < 0.001) levels were significantly associated with MACEs independent of traditional risk factors. According to quantile g-computation, the joint effect of all these metabolites was 1.86 (95% CI: 1.46, 2.27). PAGln, IS and TML had the greatest proportional positive contributions to the mixture effect. Additionally, plasma PAGln and TML combined with coronary angiography scores including the Synergy between PCI with Taxus and cardiac surgery (SYNTAX) score (area under the curve [AUC]: 0.792 vs. 0.673), Gensini score (0.794 vs. 0.647) and Balloon pump-assisted Coronary Intervention Study (BCIS-1) jeopardy score (0.774 vs. 0.573) showed better prediction performance for MACEs.Conclusions: Higher plasma PAGln, IS, DCA, TML , TMAO levels are independently associated with MACEs suggesting that these metabolites may be useful markers for prognosis in patients with STEMI.

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