Plasma desmosine, a biomarker of elastin degradation, predicts outcomes in coronary artery disease

Z. Iskandar, S. Patel, T. Lancefield, M. Freeman, M. Horrigan, O. Farouque, J. T. J. Huang, C. C. Lang, L. M. Burrell, A. M. Choy

Research output: Contribution to journalArticlepeer-review


Background: Recent evidence from animal studies suggests that elastin degradation accelerates atherosclerosis and increases risk of plaque rupture and subsequent myocardial infarction and stroke. Desmosine is an elastin-specific degradation product. We analysed the prognostic value of plasma desmosine (pDES) in a cohort of patients with coronary artery disease (CAD).

Methods: Patients with CAD (n=400) undergoing elective coronary angiography were prospectively recruited over 3 years and had bloods drawn for analysis of pDES using a validated stable isotope dilution liquid chromatography-tandem mass spectrometry method. Patients were followed up for 12 months for major adverse cardiovascular events (MACE: composite of death, myocardial infarction, target vessel repeat revascularisation, target lesion revascularisation, and heart failure hospital admission). The upper limit of normal for pDES is 0.35 ng/mL. The predictive value of pDES for MACE was analysed with Cox-proportional hazards ratio (HR) model and Kaplan-Meier survival analysis.

Results: During follow-up, there were 36 MACE events. Median pDES level across the entire cohort was 0.3 ng/mL (IQR 0.23–0.41 ng/mL). Patients with a pDES level >0.35 ng/mL were more likely to be male and older with a mean age of 69.7±10.3 years, have a history of prior stroke or transient ischaemic attack (TIA) and COPD. In univariable analysis, a pDES level of >0.35 ng/mL was associated with an increased risk of MACE (HR 4.76, 95% CI: 2.34–9.68, p<0.001). In multivariable analysis, pDES >0.35 ng/mL was associated with risk of MACE after adjustment for age, sex, COPD status and previous stroke and TIA (HR 3.97; 95% CI: 1.82–8.67, p=0.001) (Figure).

Conclusion: Increased elastin degradation as measured by elevated pDES levels, predicts outcomes in patients with CAD independent of traditional cardiovascular risk factors and may play a role as a future biomarker in these patients.
Original languageEnglish
Pages (from-to)1351
Number of pages1
JournalEuropean Heart Journal
Issue numberSupplement 2
Early online date25 Nov 2020
Publication statusPublished - 25 Nov 2020
EventESC Congress 2020: The Digital Experience - Amsterdam, Netherlands
Duration: 29 Aug 20202 Sept 2020


  • Coronary Artery Disease - Epidemiology
  • Prognosis
  • Outcome


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