July 31, 2026Journal of the American College of Cardiology159 citationsOpen Access
Serial Measurement of Monocyte Chemoattractant Protein-1 After Acute Coronary Syndromes
Key Result
Baseline MCP-1 >238 pg/ml after acute coronary syndromes was independently associated with increased mortality (HR 2.16; 95% CI 1.54-3.02).
Key Points
- This study aims to evaluate if monocyte chemoattractant protein-1 improves risk assessment for patients after acute coronary syndromes.
- Monocyte chemoattractant protein-1 measured at baseline, 4 months, and 12 months in 4,244 participants
- Correlations between MCP-1 levels and clinical events analyzed in the Z phase of the A to Z trial
- Assessed prognostic value after adjusting for standard risk factors and other biomarkers like C-reactive protein.
- MCP-1 levels >238 pg/ml associated with increased mortality (HR 2.16, 95% CI 1.54-3.02, p < 0.01)
- C-statistic for mortality model improved from 0.76 to 0.78 with MCP-1 inclusion (p < 0.0001)
- MCP-1 >238 pg/ml at 4 months linked to higher mortality risk (HR 1.76, 95% CI 1.12-2.76).
Study Design
Type
Cohort (n=4,244)
PICO
P
Population
4,244 patients with acute coronary syndromes evaluated for the prognostic value of monocyte chemoattractant protein-1 at baseline, 4 months, and 12 months.
E
Exposure / Comparator
Monocyte chemoattractant protein-1 (MCP-1) >238 pg/ml vs MCP-1 ≤238 pg/ml
O
Primary Outcome
Mortality — HR 2.16 (1.54-3.02)
Main Result
Hazard Ratio: 2.16 (95% CI 1.54–3.02)
Abstract
OBJECTIVES: This study sought to determine whether the novel biomarker monocyte chemoattractant protein (MCP)-1 adds prognostic value to standard risk assessment tools and biomarkers after acute coronary syndromes (ACS). BACKGROUND: Monocyte chemoattractant protein-1 is a chemokine recruiting signal for monocytes that may function as both a mediator and biomarker of ACS. METHODS: Monocyte chemoattractant protein-1 was measured at baseline (n = 4,244), 4 months (n = 3,603), and 12 months (n = 2,950), and correlated with clinical events in the Z phase of the A to Z (Aggrastat to Zocor) trial, which compared early intensive versus delayed and less intensive statin therapy after ACS. RESULTS: Rates of death and the composite end points of death or myocardial infarction (MI); death, MI, or heart failure; and cardiovascular death, MI, readmission for ACS, or stroke increased across baseline quartiles of MCP-1 and among patients with MCP-1 greater than versus less than or equal to the pre-specified threshold of 238 pg/ml (p 238 pg/ml remained independently associated with mortality (hazard ratio 2.16; 95% confidence interval 1.54 to 3.02) and with each composite end point, and increased the C-statistic of the fully adjusted mortality model from 0.76 to 0.78 (p 238 pg/ml at the 4-month follow-up visit was also independently associated with mortality after 4 months (hazard ratio 1.76; 95% confidence interval 1.12 to 2.76). Elevated MCP-1 levels did not identify patients who derived incremental benefit from intensive statin therapy. CONCLUSIONS: Monocyte chemoattractant protein-1 provides independent prognostic value in the acute and chronic phases after ACS and merits further evaluation as a prognostic marker and potential therapeutic target.