Cathepsin S Levels and Survival Among Patients With Non-ST-Segment Elevation Acute Coronary Syndromes

• Published in: Journal of the American College of Cardiology 2022-09, Vol.80 (10), p.998-1010
• Main Authors: Stamatelopoulos, Kimon, Mueller-Hennessen, Matthias, Georgiopoulos, Georgios, Lopez-Ayala, Pedro, Sachse, Marco, Vlachogiannis, Nikolaos I., Sopova, Kateryna, Delialis, Dimitrios, Bonini, Francesca, Patras, Raphael, Ciliberti, Giorgia, Vafaie, Mehrshad, Biener, Moritz, Boeddinghaus, Jasper, Nestelberger, Thomas, Koechlin, Luca, Tual-Chalot, Simon, Kanakakis, Ioannis, Gatsiou, Aikaterini, Katus, Hugo, Spyridopoulos, Ioakim, Mueller, Christian, Giannitsis, Evangelos, Stellos, Konstantinos
• Format: Article
• Language: English
• Subjects: cathepsin S; GRACE; NSTE-ACS; reclassification; residual risk; risk stratification
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2022.05.055

Patients with non–ST-segment elevation acute coronary syndromes (NSTE-ACS) are at high residual risk for long-term cardiovascular (CV) mortality. Cathepsin S (CTSS) is a lysosomal cysteine protease with elastolytic and collagenolytic activity that has been involved in atherosclerotic plaque rupture. The purpose of this study was to determine the following: 1) the prognostic value of circulating CTSS measured at patient admission for long-term mortality in NSTE-ACS; and 2) its additive value over the GRACE (Global Registry of Acute Coronary Events) risk score. This was a single-center cohort study, consecutively recruiting patients with adjudicated NSTE-ACS (n = 1,112) from the emergency department of an academic hospital. CTSS was measured in serum using enzyme-linked immunosorbent assay. All-cause mortality at 8 years was the primary endpoint. CV death was the secondary endpoint. In total, 367 (33.0%) deaths were recorded. CTSS was associated with increased risk of all-cause mortality (HR for highest vs lowest quarter of CTSS: 1.89; 95% CI: 1.34-2.66; P < 0.001) and CV death (HR: 2.58; 95% CI: 1.15-5.77; P = 0.021) after adjusting for traditional CV risk factors, high-sensitivity C-reactive protein, left ventricular ejection fraction, high-sensitivity troponin-T, revascularization and index diagnosis (unstable angina/ non–ST-segment elevation myocardial infarction). When CTSS was added to the GRACE score, it conferred significant discrimination and reclassification value for all-cause mortality (Delta Harrell’s C: 0.03; 95% CI: 0.012-0.047; P = 0.001; and net reclassification improvement = 0.202; P = 0.003) and CV death (AUC: 0.056; 95% CI: 0.017-0.095; P = 0.005; and net reclassification improvement = 0.390; P = 0.001) even after additionally considering high-sensitivity troponin-T and left ventricular ejection fraction. Circulating CTSS is a predictor of long-term mortality and improves risk stratification of patients with NSTE-ACS over the GRACE score. [Display omitted]