Prognostic Significance of Soluble PD-L1 on Cardiovascular Outcomes in Patients with Coronary Artery Disease
Shuhei Miyazaki, Koichiro Fujisue, Kenshi Yamanaga, Daisuke Sueta, Hiroki Usuku, Noriaki Tabata, Masanobu Ishii, Shinsuke Hanatani, Tadashi Hoshiyama, Hisanori Kanazawa, Seiji Takashio, Yuichiro Arima, Satoshi Araki, Eiichiro Yamamoto, Kenichi Matsushita, Kenichi Tsujita
Abstract
AIMS: Programmed cell death-1 (PD-1) and its ligand (PD-L1) regulate T cells, leading to immunotolerance. We previously demonstrated that patients with coronary artery disease (CAD) had increased circulating levels of soluble PD-L1 (sPD-L1). However, the prognostic significance of sPD-L1 on cardiovascular outcomes is unknown. In the present study, we evaluated the association between sPD-L1 and cardiovascular events in patients with CAD. METHODS: We prospectively measured sPD-L1 in patients with CAD admitted to Kumamoto University Hospital between December 2017 and January 2020 and observed their cardiovascular event rate. The primary outcome was a composite of death from non-cardiovascular causes, death from cardiovascular causes, non-fatal myocardial infarction, unstable angina pectoris, revascularization, hospitalization for heart failure, and ischemic stroke. RESULTS: , B-type natriuretic peptide, left ventricular ejection fraction, and sPD-L1 were significantly associated with cardiovascular events. Multivariable Cox proportional hazards analysis of factors that were significant in univariate analysis identified that sPD-L1 was significantly and independently associated with cardiovascular events (hazard ratio: 1.364, 95% confidence interval: 1.018-1.828, p=0.038). CONCLUSIONS: Higher sPD-L1 levels were significantly associated with future cardiovascular events in patients with CAD.