Whole blood choline and plasma choline in acute coronary syndromes: prognostic and pathophysiological implications.

Abstract Background Whole blood choline (WBCHO) and plasma choline (PLCHO) concentrations increase rapidly after stimulation of phospholipase D in acute coronary syndromes (ACS). Early risk-stratification was analyzed in 217 patients with suspected ACS and a negative admission troponin T ( Methods WBCHO and PLCHO were measured using high-performance-liquid-chromatography mass spectrometry. Major cardiac events (MACE) were defined as cardiac death/arrest, coronary intervention or myocardial infarction (MI). Results WBCHO (≥ 28.2 μmol/L) was predictive for MACE (hazard ratio [HR] 2.7; p p  = 0.015), heart failure (HR 2.8; p  = 0.003), coronary intervention (HR 2.1; p  = 0.01) and MI (HR 8.4; p  = 0.002) after 30 days. PLCHO (≥ 25.0 μmol/L) was predictive for MACE (HR 2.6; p  = 0.005), cardiac death/arrest (HR 15.7; p p p  = 0.009 and OR 3.3, p  = 0.03) independently of age, gender, prior MI, coronary risk factors and ECG. Conclusions WBCHO and PLCHO are significant and independent predictors of major cardiac events in admission troponin T negative acute coronary syndromes. Both are predictive for events related to tissue ischemia and WBCHO is capable of detecting risks associated with coronary plaque instability.