Newer Antiphospholipid Antibodies Predict Adverse Outcomes in Patients With Acute Coronary Syndrome

Antiphospholipid antibodies (aPLs) have been implicated in atherogenesis. We studied 344 patients with acute coronary syndromes; approximately 40% were aPL+ in I or more tests and 60% aPL-. In 215 patients, coronary artery disease (CAD) was angiographically documented, with 43.7% positive for aft vs 34.9% of patients without CAD positive for aPLs. Anti-beta(2)-glycoprotein I (B2GPI; 54%) and anti-oxidized low-density; lipoprotein (oxLDL)/beta 2GPI (48%) were most frequent, accounting for 87% of all aPL+ CAD cases. aPLs correlated with severity of CAD (P=.012). Adverse events occurred in 16 7% of patients with CAD, more frequently in patients who were aPL+ (P=.0006; relative risk, 2.9; 95% confidence interval, 1.5-5.6). Patients who were aPL + with severe CAD had more adverse events than patients who were aPL- with severe CAD (P=.005) and aPL+patients undergoing revascularization procedures (P=.001). Vascular events occurred in 21.7% of aPL + patients compared with 7.1% of aPL-patients (P=.005). Anti-beta 2GPI and anti-oxLDL/beta 2GPI were associated with CAD severity and adverse outcomes.