T numbers are shown in Table 3). All these parameters were next tested in a stepwise multiple logistic regression model. In the multivariate analysis, significant predictors of death were the concentration of TRAIL (OR 0.053 (95 CI 0.004?.744), p = 0.029), older age (OR 1.20 (95 CI 1.02?.41, p = 0.026) and serum creatinine (OR 15.1 (95 CI 1.56?45.2), p = 0.0193).BMI ?body mass index, DM ?the presence of diabetes mellitus, AF ?the presence of atrial fibrillation during index hospitalization, smoking status ?smoking before admission, STEMI ?myocardial infarction with ST-segment elevation, LV EF ?ejection fraction of left ventricle, glucose ?the concentration of 12926553 glucose at admission, ACEI ?the admission of angiotensin ?converting enzyme blockers at discharge, aspirin ?the admission of aspirin at discharge, statin ?the admission of statin at discharge, ALT ?alanine aminotransferase, CAD severity ?the extension of coronary artery disease, Complete SIS 3 web revascularization ?the absence of any stenosis of 60 or more in at least one coronary artery at discharge. doi:10.1371/journal.pone.0053860.tSecondary endpoint: re-MI The concentration of apoptotic moleculesThe concentration of Fas was higher in the End-point group (7440 [5774?443] pg/mL vs. 6530 [5702?009] pg/mL) in the End-point free group; however, this difference was not statistically significant. The concentration of sTRAIL was significantly lower in the End-point group (23.7 [19.2?0.4] pg/mL vs. 57.1 [38.9?72.9] pg/mL in the End-point free group, p,0.001, Figure 1). End-point patients also had higher concentrations of BNP: 1699 [1238?200] pg/mL vs. 297 [60?77] pg/mL, p,0.001), higher peak troponin I levels: 148.26146.8 ng/mL vs. 59.6677.2 ng/ Re-MI occurred in 11 patients within 6 months of follow-up. In the univariate regression model, only the concentration of TRAIL and maximum troponin level were significantly associated with reMI and were therefore entered into the multiple logistic model. However, in a stepwise multiple logistic regression model, none from above mentioned parameters was significant predictor of reMI.Prognosis in ACS Patients by Apoptotic MoleculesFigure 1. Serum concentration of soluble TRAIL. Data are expressed as median with interquartile ranges. Statistical comparison was done by Wilcoxon test. doi:10.1371/journal.pone.0053860.gSecondary endpoint: strokeOnly 3 (1 ) patients underwent a stroke during follow-up of six months. Therefore, this endpoint could not been sufficiently statistically analyzed.Receiver operating characteristic analysisReceiver operating characteristic curve analysis demonstrated that the concentration of soluble TRAIL was able to distinguish between patients with and without subsequent combined endpoint (area under the curve 0.85, 15755315 95 CI 0.78?,93, p,0.001; Figure 2). A concentration of TRAIL of 44.6 ng/mL was identified as the LY2409021 optimal cut-off to predict the combination of death and heart failure within 6 month follow-up, providing a sensitivity of 90.5 (95 CI 69.6?8.8), a specificity of 67.1 (95 CI 60.6?3.2), a negative predictive value of 98.7 (95 CI 95.4?9.8), and a positive predictive value of 20.4 (95 CI 12.8?0.1 ). A Kaplan ?Meier survival curves of patients relative to the calculated optimal concentration of TRAIL are shown in Figure 3. The differences between survival curves was statistically significant (p,0.001, log rank test).DiscussionHeart failure resulting from ACS is one of the leading causes of death in western countries.T numbers are shown in Table 3). All these parameters were next tested in a stepwise multiple logistic regression model. In the multivariate analysis, significant predictors of death were the concentration of TRAIL (OR 0.053 (95 CI 0.004?.744), p = 0.029), older age (OR 1.20 (95 CI 1.02?.41, p = 0.026) and serum creatinine (OR 15.1 (95 CI 1.56?45.2), p = 0.0193).BMI ?body mass index, DM ?the presence of diabetes mellitus, AF ?the presence of atrial fibrillation during index hospitalization, smoking status ?smoking before admission, STEMI ?myocardial infarction with ST-segment elevation, LV EF ?ejection fraction of left ventricle, glucose ?the concentration of 12926553 glucose at admission, ACEI ?the admission of angiotensin ?converting enzyme blockers at discharge, aspirin ?the admission of aspirin at discharge, statin ?the admission of statin at discharge, ALT ?alanine aminotransferase, CAD severity ?the extension of coronary artery disease, Complete revascularization ?the absence of any stenosis of 60 or more in at least one coronary artery at discharge. doi:10.1371/journal.pone.0053860.tSecondary endpoint: re-MI The concentration of apoptotic moleculesThe concentration of Fas was higher in the End-point group (7440 [5774?443] pg/mL vs. 6530 [5702?009] pg/mL) in the End-point free group; however, this difference was not statistically significant. The concentration of sTRAIL was significantly lower in the End-point group (23.7 [19.2?0.4] pg/mL vs. 57.1 [38.9?72.9] pg/mL in the End-point free group, p,0.001, Figure 1). End-point patients also had higher concentrations of BNP: 1699 [1238?200] pg/mL vs. 297 [60?77] pg/mL, p,0.001), higher peak troponin I levels: 148.26146.8 ng/mL vs. 59.6677.2 ng/ Re-MI occurred in 11 patients within 6 months of follow-up. In the univariate regression model, only the concentration of TRAIL and maximum troponin level were significantly associated with reMI and were therefore entered into the multiple logistic model. However, in a stepwise multiple logistic regression model, none from above mentioned parameters was significant predictor of reMI.Prognosis in ACS Patients by Apoptotic MoleculesFigure 1. Serum concentration of soluble TRAIL. Data are expressed as median with interquartile ranges. Statistical comparison was done by Wilcoxon test. doi:10.1371/journal.pone.0053860.gSecondary endpoint: strokeOnly 3 (1 ) patients underwent a stroke during follow-up of six months. Therefore, this endpoint could not been sufficiently statistically analyzed.Receiver operating characteristic analysisReceiver operating characteristic curve analysis demonstrated that the concentration of soluble TRAIL was able to distinguish between patients with and without subsequent combined endpoint (area under the curve 0.85, 15755315 95 CI 0.78?,93, p,0.001; Figure 2). A concentration of TRAIL of 44.6 ng/mL was identified as the optimal cut-off to predict the combination of death and heart failure within 6 month follow-up, providing a sensitivity of 90.5 (95 CI 69.6?8.8), a specificity of 67.1 (95 CI 60.6?3.2), a negative predictive value of 98.7 (95 CI 95.4?9.8), and a positive predictive value of 20.4 (95 CI 12.8?0.1 ). A Kaplan ?Meier survival curves of patients relative to the calculated optimal concentration of TRAIL are shown in Figure 3. The differences between survival curves was statistically significant (p,0.001, log rank test).DiscussionHeart failure resulting from ACS is one of the leading causes of death in western countries.
