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European Heart Journal Advance Access originally published online on November 21, 2008
European Heart Journal 2009 30(1):25-32; doi:10.1093/eurheartj/ehn513
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

Prognostic value of circulating chromogranin A levels in acute coronary syndromes

Anna M. Jansson1,2,{dagger}, Helge Røsjø3,4,{dagger}, Torbjørn Omland3,4, Thomas Karlsson5, Marianne Hartford5,6, Allan Flyvbjerg7 and Kenneth Caidahl1,8,9,*

1 Department of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
2 Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden
3 Department of Medicine, Akershus University Hospital, Lørenskog, Norway
4 Faculty Division Akershus University Hospital, University of Oslo, Oslo, Norway
5 Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
6 AstraZeneca R&D, Mölndal, Sweden
7 The Medical Research Laboratories, Medical Department M (Diabetes and Endocrinology), Clinical Institute, Aarhus University Hospital, Aarhus, Denmark
8 Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
9 Department of Clinical Physiology, Karolinska University Hospital N2:01, SE-171 76 Stockholm, Sweden

Received 29 March 2008; revised 12 October 2008; accepted 23 October 2008; online publish-ahead-of-print 21 November 2008.

* Corresponding author. Tel: +46 8 517 77 510, Fax: +46 8 51773800, Email: kenneth.caidahl{at}ki.se

Aims: To determine whether circulating levels of chromogranin A (CgA) provide prognostic information independently of conventional risk markers in acute coronary syndromes (ACSs).

Methods and results: We measured circulating CgA levels on day 1 in 1268 patients (median age 67 years, 70% male) with ACS admitted to a single coronary care unit of a Scandinavian teaching hospital. The merit of CgA as a biomarker was evaluated after adjusting for conventional cardiovascular risk factors. During a median follow-up of 92 months, 389 patients (31%) died. The baseline CgA concentration was strongly associated with increased long-term mortality [hazard ratio per 1 standard deviation increase in logarithmically transformed CgA level: 1.57 (1.44–1.70), P < 0.001], heart failure hospitalizations [1.54 (1.35–1.76), P < 0.001], and recurrent myocardial infarction (MI) [1.27 (1.10–1.47), P < 0.001], but not stroke. After adjustment for conventional cardiovascular risk markers, the association remained significant for mortality [hazard ratio 1.28 (1.15–1.42), P < 0.001] and heart failure hospitalization [hazard ratio 1.24 (1.04–1.47), P = 0.02], but not recurrent MI.

Conclusion: CgA is an independent predictor of long-term mortality and heart failure hospitalizations across the spectrum of ACSs and provides incremental prognostic information to conventional cardiovascular risk markers.

Key Words: Acute coronary syndromes • Chromogranin A • Troponin T • Echocardiography • Prognosis

{dagger} These two authors have contributed equally to the work.


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