Increased titres of anti-human heat shock protein 60 predict an adverse one year prognosis in patients with acute cardiac chest pain

Abstract

Objective: To assess whether antibodies to human heat shock protein 60 (anti-huhsp60) or to mycobacterial heat shock protein 65 (anti-mhsp65) predict an adverse one year prognosis in patients admitted with acute cardiac chest pain.

Design: Prospective observational study.

Setting: Teaching hospital.

Patients: 588 consecutive emergency admissions of patients with acute chest pain of suspected cardiac origin.

Main outcome measures: Anti-huhsp60 and anti-mhsp65 titres were assayed on samples drawn on the morning after admission. The end points after discharge were coronary heart disease death, non-fatal myocardial infarction, coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, angiogram, or readmission with further cardiac ischaemic chest pain.

Results: During follow up after discharge (mean of 304 days, range 1-788 days), 277 patients had at least one of the study outcomes. Patients with increased titres of anti-huhsp60 had an adverse prognosis (hazard ratio 1.56 (95% confidence interval 1.09 to 2.23) comparing highest versus lowest quartiles, p = 0.015). Anti-mhsp65 titres were not predictive.

Conclusions: Patients admitted with acute cardiac chest pain and increased titres of anti-huhsp60 had an adverse one year prognosis.

Figure 1

Kaplan-Meier survival plot of time to first hard end point by anti-human heat shock protein 60 (anti-huhsp60) quartiles (Q1 to Q4).

Figure 2

Kaplan-Meier survival plot of time to first hard plus soft end point by anti-huhsp60 quartiles (Q1 to Q4).