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. 2025 Apr 15;14(8):e035620.
doi: 10.1161/JAHA.124.035620. Epub 2025 Apr 3.

Amyloid β1-40 Predicts Long-Term Mortality Rate in Patients With Acute Myocardial Infarction

Aneta Aleksova  1   2 , Alessandra Lucia Fluca  1   2 , Alessandro Pierri  3 , Giulia Barbati  4 , Antonio Paolo Beltrami  5   6 , Laura Padoan  7 , Enzo Merro  1   2 , Maria Marketou  8 , Donna Zwas  9 , Stefano D'Errico  2 , Gianfranco Sinagra  1   2 , Milijana Janjusevic  1   2
Affiliations

Amyloid β1-40 Predicts Long-Term Mortality Rate in Patients With Acute Myocardial Infarction

Aneta Aleksova et al. J Am Heart Assoc. .

Abstract

Background: Amyloid β1-40 (Aβ1-40) contributes to atherosclerosis, being involved in plaque formation and destabilization. The prognostic role of Aβ1-40 in patients with acute myocardial infarction is currently limited to non-ST-segment-elevation myocardial infarction (NSTEMI). We examined the prognostic value of Aβ1-40 in a real-world cohort of patients with acute myocardial infarction (both ST-segment-elevation myocardial infarction [STEMI] and NSTEMI) and identified predictors for its elevated levels.

Methods and results: Our population included 1119 consecutive patients (mean age, 67 years; 72% men; and STEMI, 68%). The median Aβ1-40 concentration on admission was 86.9 (interquartile range, 54.5-128.9) pg/mL, and there was no difference in Aβ1-40 levels between NSTEMI and STEMI (P=0.1). Higher Aβ1-40 levels were predicted by older age, lower left ventricular ejection fraction, glycated hemoglobin >39 mmol/mol and glomerular filtration rate <60 mL/min per m2. From the final multivariable model, a nomogram was computed to determine probability of high Aβ1-40. During the median follow-up of 57 months, 193 patients (17.2%) died. Kaplan-Meier analysis revealed higher mortality risk in patients with Aβ1-40 levels above the median (P<0.01), consistent across STEMI (P<0.01) and NSTEMI (P=0.01) subgroups. At Cox multivariable analysis including the entire cohort, Aβ1-40 levels were predictive of death (hazard ratio, 1.03; P=0.01), together with older age, higher high-sensitivity C-reactive protein levels, smoking, glomerular filtration rate <60 mL/min per m2, worse left ventricular ejection fraction, and previous ischemic events. In the STEMI subcohort, Aβ1-40 remained a significant predictor, along with advanced age, worse left ventricular ejection fraction, smoking, and elevated high-sensitivity C-reactive protein. No such association was found in patients with NSTEMI (P=0.17), likely due to the smaller cohort size and low event rate.

Conclusions: Aβ1-40 is an independent predictor of death and improves risk stratification in patients with acute myocardial infarction.

Keywords: NSTEMI; STEMI; acute myocardial infarction; amyloid β1‐40; death; risk stratification.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1. Aβ1‐40 values stratified according to (A) age, (B) LVEF, (C) GFR, and (D) diabetes.
Aβ1‐40 indicates amyloid‐β 1‐40; GFR, glomerular filtration rate; and LVEF, left ventricular ejection fraction.
Figure 2
Figure 2. Kaplan–Meier analysis.
The curve of survival for (A) the overall cohort, (B) STEMI, and (C) NSTEMI cohorts. Aβ1‐40 indicates amyloid‐β 1‐40; NSTEMI, non–ST‐segment–elevation myocardial infarction; and STEMI, ST‐elevation myocardial infarction.
Figure 3
Figure 3. Time‐dependent receiver operating characteristics analysis for the multivariable model including Aβ1‐40 (A) in the overall cohort and (B) STEMI subcohort.
AUC indicates area under the curve; Aβ1‐40 amyloid‐β 1‐40; and STEMI, ST‐segment–elevation myocardial infarction.
Figure 4
Figure 4. Nomogram for Aβ1‐40 levels prediction (A) and clinical variables (derived from the nomogram) and relative score used to predict the Aβ1‐40 levels (B).
Aβ1‐40 indicates amyloid‐β 1‐40; HbA1c, glycosylated hemoglobin; and LVEF, left ventricular ejection fraction.
See this image and copyright information in PMC

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