Protein Z levels and prognosis in patients with acute coronary syndromes
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Abstract
Background: Protein Z, a vitamin K-dependent glycoprotein, serves as a cofactor for the inhibition of activated coagulation factor X. During recent years, a role for low levels of protein Z in prothrombotic disorders such as ischemic stroke and acute coronary syndromes (ACS) has been reported. The aims of this study were to test changes in protein Z and their association with outcome at 1-year follow-up in 193 (150 male, 43 female) patients with ACS.
Results: Protein Z plasma levels were significantly lower (p<0.0001) after 1year [1600 (28–3736) ng/mL] compared to the baseline [1695 (294–4068) ng/mL]. Regression analysis showed a significant association between baseline protein Z below the 5th percentile of our control group and subsequent adverse cardiac events at follow-up (odds ratio 3.3; 95% CI 1.04–10.7; p=0.04). Moreover, Cox regression analysis showed that low protein Z levels at admission were significant predictors of major adverse cardiac events (cardiac death, non-fatal recurrent myocardial infarction, and need for target lesion revascularization) after 1year (hazard risk 2.5; 95% CI 1.02–6.5, p=0.04).
Conclusions: Our results show that in patients with ACS: 1) protein Z decreases moving from the acute to the convalescent phase; and 2) low levels of baseline protein Z are significantly associated with adverse outcome at 1-year follow-up.
Clin Chem Lab Med 2006;44:1098–102.
References
1. Broze GJ Jr, Miletich JP. Human protein Z. J Clin Invest 1984; 73:933–8.10.1172/JCI111317Search in Google Scholar
2. Ichinose A, Takeya H, Espling E, Iwanaga S, Kisiel W, Davie EW. Amino acid sequence of human protein Z, a vitamin K-dependent plasma glycoprotein. Biochem Biophys Res Commun 1990; 172:1139–44.10.1016/0006-291X(90)91566-BSearch in Google Scholar
3. Han X, Fiehler R, Broze GJ Jr. Isolation of a protein Z-dependent plasma protease inhibitor. Proc Natl Acad Sci USA 1998; 95:9250–5.10.1073/pnas.95.16.9250Search in Google Scholar
4. Kobelt K, Biasiutti FD, Mattle HP, Lammle B, Wuillemin WA. Protein Z in ischaemic stroke. Br J Haematol 2001; 114:169–73.10.1046/j.1365-2141.2001.02913.xSearch in Google Scholar
5. Vasse M, Guegan-Massardier E, Borg JY, Woimant F, Soria C. Frequency of protein Z deficiency in patients with ischaemic stroke. Lancet 2001; 357:933–4.10.1016/S0140-6736(00)04218-5Search in Google Scholar
6. Lopaciuk S, Bykowska K, Kwiecinski H, Czlonkowska A, Kuczynska-Zardzewialy A. Protein Z in young survivors of ischemic stroke. Thromb Haemost 2002; 88:536.10.1055/s-0037-1613250Search in Google Scholar
7. Heeb MJ, Paganini-Hill A, Griffin JH, Fisher M. Low protein Z levels and risk of ischemic stroke: differences by diabetic status and gender. Blood Cells Mol Dis 2002; 29:139–44.10.1006/bcmd.2002.0549Search in Google Scholar PubMed
8. McQuillan AM, Eikelboom JW, Hankey GJ, Baker R, Thom J, Staton J, et al. Protein Z in ischemic stroke and its etiologic subtypes. Stroke 2003; 34:2415–9.10.1161/01.STR.0000092124.52084.4BSearch in Google Scholar PubMed
9. Staton J, Sayer M, Hankey GJ, Cole V, Thom J, Eikelboom JW. Protein Z gene polymorphisms, protein Z concentrations, and ischemic stroke. Stroke 2005; 36:1123–7.10.1161/01.STR.0000166058.49577.caSearch in Google Scholar PubMed
10. Fedi S, Sofi F, Brogi D, Tellini I, Cesari F, Sestini I, et al. Low protein Z plasma levels are independently associated with acute coronary syndromes. Thromb Haemost 2003; 90:1173–8.10.1160/TH03-04-0237Search in Google Scholar PubMed
11. Sofi F, Cesari F, Vigiani S, Fatini C, Marcucci R, Giglioli C, et al. Protein Z levels in different phases of activity of coronary atherosclerosis. J Thromb Haemost 2005; 3:2254–8.10.1111/j.1538-7836.2005.01536.xSearch in Google Scholar
12. Undar L, Karadogan I, Ozturk F. Plasma protein Z levels inversely correlate with plasma interleukin-6 levels in patients with acute leukaemia and non-Hodgkin's lymphoma. Thromb Res 1999; 94:131–4.10.1016/S0049-3848(98)00210-2Search in Google Scholar
13. Vasse M, Denoyelle C, Legrand E, Vannier JP, Soria C. Weak regulation of protein Z biosynthesis by inflammatory cytokines. Thromb Haemost 2002; 87:350–1.10.1055/s-0037-1613003Search in Google Scholar
14. Morange PE, Juhan-Vague I, on behalf of the PRIME study group. Protein Z plasma levels are not associated with the risk of coronary heart disease: the PRIME study. J Thromb Haemost 2004; 2:2050–1.10.1111/j.1538-7836.2004.00981.xSearch in Google Scholar
15. Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD, Hochman JS, et al. ACC/AHA guideline update for the management of patients with unstable angina and non-ST-segment elevation of myocardial infarction – summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients with Unstable Angina). J Am Coll Cardiol 2002; 40:1366–74.10.1016/S0735-1097(02)02336-7Search in Google Scholar
16. Cifkova R, Erdine S, Fagard R, Farsang C, Heagerty AM, Kiowski W, et al., ESH/ESC Hypertension Guidelines Committee. Practice guidelines for primary care physicians: 2003 ESH/ESC Hypertension guidelines. Hypertension 2003; 21:1779–86.10.1097/00004872-200310000-00001Search in Google Scholar
17. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 2003;26:5–20.10.2337/diacare.26.2007.S5Search in Google Scholar PubMed
18. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment in Panel III). Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002;106:3143–421.10.1161/circ.106.25.3143Search in Google Scholar
19. Sofi F, Cesari F, Fedi S, Abbate R, Gensini GF. Protein Z: “light and shade” of a new thrombotic factor. Clin Lab 2004; 50:647–52.Search in Google Scholar
©2006 by Walter de Gruyter Berlin New York
Articles in the same Issue
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- Low-density lipoprotein receptor-related protein 5 and vitamin D receptor gene polymorphisms in relation to vitamin D levels in menopause
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- Molecular assay for detection of the common carnitine palmitoyltransferase 1A 1436(C>T) mutation
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- Analysis of protein S-100B in serum: a methodological study
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Articles in the same Issue
- Point-of-care testing – can we move from anecdote to evidence?
- A long and winding road: defining the biological role and clinical importance of paraoxonases
- Point-of-care testing in the cardiovascular operating theatre
- Low-density lipoprotein receptor-related protein 5 and vitamin D receptor gene polymorphisms in relation to vitamin D levels in menopause
- The methylenetetrahydrofolate reductase C677T gene mutation is associated with hyperhomocysteinemia, cardiovascular disease and plasma B-type natriuretic peptide levels in Korea
- Exploring allelic imbalance within paraffin-embedded tumor biopsies using pyrosequencing technology
- Detection of circulating tumour cells in blood by quantitative real-time RT-PCR: effect of pre-analytical time
- Hereditary hyper-ACE-emia due to the Pro1199Leu mutation of somatic ACE as a potential pitfall in diagnosis: a first family outside Europe
- Molecular assay for detection of the common carnitine palmitoyltransferase 1A 1436(C>T) mutation
- Serum cytokine levels and the expression of estrogen and progesterone receptors in breast cancer patients
- Protein Z levels and prognosis in patients with acute coronary syndromes
- Determination of total bilirubin in whole blood from neonates: results from a French multicenter study
- Analysis of protein S-100B in serum: a methodological study
- Lipid peroxidation and homocysteine levels in Behçet's disease
- Lower expression of the α2,3-sialylated fibronectin glycoform and appearance of the asialo-fibronectin glycoform are associated with high concentrations of fibronectin in human seminal plasma with abnormal semen parameters
- Automated processing of whole blood samples for the determination of immunosuppressants by liquid chromatography tandem-mass spectrometry
- Role of methionine residues of albumin in T-R conversion of hemoglobin
- Rheumatoid factor interference in the determination of carbohydrate antigen 19-9 (CA 19-9)
- Significance of Elecsys® S100 immunoassay for real-time assessment of traumatic brain damage in multiple trauma patients
- IFCC primary reference procedures for the measurement of catalytic activity concentrations of enzymes at 37°C: International Federation of Clinical Chemistry and Laboratory Medicine (IFCC): Scientific Division, Committee on Reference Systems for Enzymes (C-RSE): Part 8. Reference procedure for the measurement of catalytic concentration of α-amylase: [α-Amylase: 1,4-α-D-glucan 4-glucanohydrolase (AMY), EC 3.2.1.1]
- ESEAP: the national External Quality Assessment Scheme for clinical chemistry in Greece and Cyprus
- Evaluation of whole-genome amplification using multiple-displacement amplification of a limited number of cells
- Comparison of various methods for the determination of total protein in urine
- Description of examinations and their results and ISO standard 15189
- Congress of Clinical Chemistry and Laboratory Medicine, Annual Congress of the Society of Clinical Chemistry and Laboratory Medicine (DGKL) in association with The Austrian Society for Laboratory Medicine and Clinical Chemistry, The Swiss Society for Clinical Chemistry (SGKC), The German Association of Technical Assistants in Medicine (dvta), Mannheim, Germany, October 1st - 4th, 2006
- First Congress of the Austrian Society for Laboratory Medicine and Clinical Chemistry (ÖGLMKC), Salzburg, October 4 – 7, 2006
