Circulating Serpina3 levels predict the major adverse cardiac events in patients with myocardial infarction

Background: Serine proteinase inhibitor A3 (Serpina3), initially discovered as an acute phase plasma protease inhibitor, has been demonstrated in the pathology of complex human disorders, but it is yet to be discovered following acute myocardial infarction (AMI) in clinical practice. Therefore, we aimed to evaluate the relationship between Serpina3 concentrations at admission and the risk of major adverse cardiovascular events (MACE) in patients with AMI.

Methods: A total of 120 AMI patients and 60 healthy participants were consecutively enrolled in our study. Clinical parameters variables were collected, and MACE was followed since hospitalization.

Results: Plasma concentrations of Serpina3 were elevated after AMI [159.11 (121.81, 237.07) vs. 300.18 (187.90, 478.59) μg/mL, P < 0.001]. Multivariate linear regression analysis indicated that total cholesterol (standardized β = -0.204, P = 0.024) and ESR (standardized β = 0.513, P < 0.001) were independent factors for Serpina3. Based on the median value of Serpina3 in the AMI population, patients were divided into the high-Serpina3 group (≥300.18 μg/mL, n = 65) and the low-Serpina3 group (<300.18 μg/mL, n = 60). After a median follow-up of 9 months, Kaplan-Meier survival analysis revealed that the MACE-free survival rate was significantly lower in AMI patients with higher Serpina3 levels (P = 0.002). Multivariate Cox proportional hazards analyses demonstrated that Serpina3 was a positive predictor of MACE (hazard ratios 4.03, 95% CI 1.25-12.98, P = 0.019).

Conclusions: Increased circulating Serpina3 levels following AMI is significantly associated with MACE, which suggest that Serpina3 may be a potential predictive marker of clinical outcomes in AMI.