Key result
Antiphospholipid antibody positivity in ACS is linked to ~3-fold higher MACE risk.
Why the study?
The prevalence of antiphospholipid antibodies among patients with ACS and their association with clinical outcomes remain unclear.
Does the presence of at least one antiphospholipid antibody increase the risk of major adverse cardiac events in patients with acute coronary syndrome undergoing primary PCI?
Cohort (n=184)
Does the presence of at least one antiphospholipid antibody increase the risk of major adverse cardiac events in patients with acute coronary syndrome undergoing primary PCI?
In patients with acute coronary syndrome undergoing primary PCI, positivity for at least one antiphospholipid antibody is present in over a quarter of patients and is associated with a three-fold increased risk of major adverse cardiac events.
Answers are grounded in this paper and cite their sources.
Antiphospholipid antibody positivity may flag higher-risk ACS post-PCI; hypothesis-generating for screening, requiring prospective validation before any practice change.
Background Antiphospholipid syndrome (APS) promotes thrombogenicity through antiphospholipid antibodies, leading to thrombotic events in both venous and arterial systems. Although uncommon, acute coronary syndrome (ACS) can occur as a thrombotic manifestation of APS. However, the prevalence of antiphospholipid antibodies among patients with ACS and their association with clinical outcomes remain unclear. Purpose We aimed to assess the prevalence and prognostic impact of antiphospholipid antibodies in patients with ACS. Methods ACS patients (N=184) who underwent primary percutaneous coronary intervention (PCI) and blood testing for antiphospholipid antibodies at hospitalization were retrospectively enrolled between October 2022 and September 2024. Antiphospholipid antibodies included lupus anticoagulant (LA), anti-cardiolipin IgG (aCL-IgG), anti-cardiolipin IgM (aCL-IgM), and beta-2-glycoprotein I (β2GPI). Depending on whether at least one antibody was present, patients were divided into a ≥1 positive group (n=49) or a negative group (n=135), and clinical characteristics were compared. Major adverse cardiac events (MACE) were defined as cardiovascular death, nonfatal myocardial infarction, stroke, or ischemia-driven revascularization. Results Overall, LA, aCL-IgG, aCL-IgM, and β2GPI antibodies were positive in 23.4%, 3.3%, 1.1%, and 0% of patients, respectively. At least one antiphospholipid antibody was positive (≥1 positive) in 26.6% of patients. Clinical characteristics are shown in Table 1. Patients with ≥1 positive antibodies had a lower prevalence of hyperlipidemia and higher eGFR values, while there were no differences in ACS characteristics. Kaplan–Meier survival curves for MACE are shown in Figure 1. Patients with ≥1 positive antibodies showed significantly worse event-free survival than those with negative antibodies (HR 3.04, 95% CI:1.27-7.63, P=0.01). Conclusion The presence of antiphospholipid antibodies is associated with worse clinical outcomes in patients with ACS, beyond conventional coronary risk factors.
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Ishii et al. (2026) conducted a cohort in Acute coronary syndrome (n=184). Antiphospholipid antibody positivity (≥1 positive antibody) vs. Negative antiphospholipid antibodies was evaluated on Major adverse cardiac events (MACE: cardiovascular death, nonfatal myocardial infarction, stroke, or ischemia-driven revascularization) (HR 3.04, 95% CI 1.27-7.63, p=0.01). Antiphospholipid antibody positivity (≥1 positive) in ACS patients was associated with worse MACE-free survival compared with negative antibodies (HR 3.04; 95% CI 1.27-7.63; P=0.01).
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