Soluble urokinase plasminogen activator receptor (suPAR) for risk stratification from undifferentiated acute chest pain through to convalescence after acute coronary syndromes

Aim The performance of plasma soluble urokinase plasminogen activator receptor (suPAR) for prediction of heart failure (HF) readmission or death within 5 years was assessed in patients incurring (i) initially undifferentiated chest pain and (ii) immediately after diagnosed acute coronary syndromes (ACS), and (iii) in recovery after ACS. Methods suPAR concentrations were measured at admission for acute chest pain patients (n=917) including confirmed ACS (26.5%), and in an independent 4-6 weeks post-ACS cohort (n=1301). suPAR’s prognostic performance, in comparison, and combination with cTnI or NT-proBNP was evaluated by risk discrimination, hazard ratios (HR) as continuous variables and cut-off concentrations across the three settings in unadjusted and adjusted analyses. Results In acute undifferentiated chest pain including the subgroup with confirmed ACS and separately post-ACS convalescence, combining suPAR and NT-proBNP yielded the highest discriminatory power for endpoints (c-statistics >0.80, ≥ Δ0.02). suPAR in the acute and post-ACS convalescent conferred additional hazard for the composite endpoint of HF/death (HR>1.4), HF (HR>1.3) and death (HR>1.2) after adjustment for risk factors including circulating cardiac markers. Although suPAR >3.65ng/mL (>83% specificity, >91% NPV) was superior in admission ACS (HR:10.5) for risk of HF/death, independent prediction for the composite endpoint remained consistent across the three settings and in men. Conclusion Plasma suPAR independently predicted risk of readmissions with HF and death, independent of key clinical indicators and cardiac markers at all points of the patient journey from acute chest pain presentation through to post-ACS convalescence. Its use in acute chest pain and ACS may augment risk stratification strategies.