Prognostic value of increased soluble thrombomodulin and increased soluble E‐selectin in ischaemic heart disease

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Abstract
Endothelial cell dysfunction is likely to be important in the pathophysiology of ischaemic heart disease and increased levels of endothelial cell markers soluble E‐selectin and soluble thrombomodulin may reflect this damage. To determine whether increased levels of these markers were predictive of disease progression, we obtained plasma from 54 patients who had survived a myocardial infarction. Soluble E‐selectin and soluble thombomodulin were measured by ELISA. After 49 months, 24 patients had suffered an additional cardiovascular event such as a second myocardial infarction or requirement for arterial surgery. Soluble E‐selectin was 60±30 ng/mL in patients who suffered an end‐point and was 54±23 ng/mL in those without an end‐point (p = 0.43). Soluble thrombomodulin was 65±24 ng/mL in patients who suffered an end‐point and was 49±19 ng/mL in patients who were free of an end‐point (p = 0.009). The major risk factors for atherosclerosis (hypercholesterolaemia, hypertension, smoking) or peak creatinine kinase levels were unable to predict the development of an end‐point. Using life tables, soluble thrombomodulin had a significant effect on survival free of an end‐point (p = 0.011). We conclude that the measurement of soluble E‐selectin is of limited value in epidemiological studies, and that raised soluble thrombomodulin is a new marker for the progression of atherosclerosis in patients with ischaemic heart disease.