The junctional protein associated with coronary artery disease predicts adverse cardiovascular events in patients with acute coronary syndromes at high residual risk

作者：Simon Kraler, Luca Liberale, Amedeo Tirandi, Margherita Moriero, Yifan Wang, Mohamed Farag, Federico Carbone, Maria Bertolotto, Valentina Pusterla, Davide Ramoni, Stefano Ministrini, Yustina M Puspitasari, Francesco Bruno, L Raber, Davide Di Vece, Christian Templin, O M Muller, François Mach, Filippo Crea, Giovanni G. Camici, Tetiana Lapikova-Bryhinska, Alexander Akhmedov, Arnold von Eckardstein, Diana A Gorog, Fabrizio Montecucco, Thomas F Lüscher · 发表于：European Heart Journal · 年份：2025 · DOI：10.1093/eurheartj/ehaf979 · 被引用次数：5 · 研究领域：Clusterin in disease pathology、Lipoproteins and Cardiovascular Health、Atherosclerosis and Cardiovascular Diseases

BACKGROUND AND AIMS: Patients with acute coronary syndromes (ACS) are at high ischaemic risk to which cholesterol, inflammation, and yet-to-be-identified pathways jointly contribute. The junctional protein associated with coronary artery disease (JCAD) drives incident cardiovascular events by acting on coagulation and fibrinolysis. This study aimed to assess whether JCAD serves as a novel marker of or target to address residual risk. METHODS: In the discovery cohort (SPUM-ACS; n = 4787), ACS patients at residual lipid risk [RLR; on-statin LDL cholesterol (LDL-c) ≥70 mg/dL or ≥1.8 mmol/L], residual inflammatory risk [RIR; on-statin high-sensitivity C-reactive protein (hs-CRP) ≥2.0 mg/L], or both (RILR; on-statin LDL-c ≥70 mg/dL and hs-CRP ≥2.0 mg/L) were identified and compared with propensity-score matched controls. Contributions of hs-CRP, LDL-c and JCAD to recurrent major adverse cardiovascular events (MACE) were analysed. In an independent cohort (RISK-PPCI study; n = 496), effects of JCAD on endogenous coagulation and fibrinolysis were gauged, and JCAD-MACE associations were externally validated. RESULTS: At 1 year, patients at RLR, RIR, or RILR were at higher MACE risk as compared to controls [hazard ratio (HR), 1.55, 95% confidence interval (CI) 1.08-2.23; HR 1.80, 95% CI 1.24-2.61; and HR 1.75, 95% CI 1.12-2.75, respectively]. In those at RLR, MACE risk rose with increasing hs-CRP and JCAD, respectively, in uni- (HR per log2 increase, 1.17, 95% CI 1.06-1.30; HR 1.29, 9...