Prognostic value of serum angiopoietin-like protein 2 in patients with acute coronary syndrome

Background Angiopoietin-like protein 2 (Angptl2) is a cytokine that is released to stimulate inflammation and accelerate atherogenesis. Our study sought to assess the predictive significance of serum Angptl2 in individuals diagnosed with acute coronary syndrome (ACS) and determine whether it can enhance prognostic performance beyond the GRACE risk score. Methods We recruited a total of 1060 patients with ACS in a consecutive manner. The levels of Angptl2 in serum were analyzed at baseline. The subjects were then followed up for 12 months to monitor the occurrence of major adverse cardiovascular events (MACE). Results The level of serum Angptl2 showed a positive correlation with the GRACE score (r = 0.54, p < 0.001). Survival analysis revealed that increased levels of serum Angptl2 were associated with higher occurrence of the composite of MACE (log-rank p < 0.001) and its specific components (log-rank p = 0.011 for all-cause death, p = 0.007 for non-fatal myocardial infarction and p < 0.001 for revascularization respectively). Throughout the follow-up period, 163 instances (15.4%) of endpoint events were documented. In terms of MACE, both serum Angptl2 levels (HR: 1.178, 95% CI: 1.058-1.313, p = 0.003) and the GRACE risk score (HR: 1.181, 95% CI: 1.007-1.385, p = 0.041) emerged as significant predictors following Cox multivariate adjustment. Additionally, the addition of serum Angptl2 to the GRACE score improved the predictive capacity for prognosis [increase in area under the receiveroperating characteristic curve (AUC) from 0.740 to 0.794, p = 0.020; net reclassification improvement (NRI) = 0.401, p = 0.001; integrated discrimination improvement (IDI) = 0.022, p = 0.008]. Conclusion Serum Angptl2 might be a useful prognostic biomarker and combining serum Angptl2 with the GRACE score increased the efficacy of prognosis prediction in ACS patients.