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Prognostic impact of alkaline phosphatase for in-hospital mortality in patients with acute coronary syndrome: a prospective cohort study in China
  1. Tongtong Yu,
  2. Yundi Jiao,
  3. Jia Song,
  4. Dongxu He,
  5. Jiake Wu,
  6. Zongyu Wen,
  7. Na Sun,
  8. Weili Duan,
  9. Zhijun Sun,
  10. Zhaoqing Sun
  1. Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
  1. Correspondence to Dr Zhaoqing Sun; sunzhaoqing{at}


Objectives Alkaline phosphatase (ALP) can promote vascular calcification, but the association between ALP and in-hospital mortality in patients with acute coronary syndrome (ACS) is not well defined.

Design A prospective cohort study.

Setting and participants A total of 6368 patients with ACS undergoing percutaneous coronary intervention (PCI) from 1 January 2010 to 31 December 2017 were analysed.

Main outcome measures In-hospital mortality was used in this study.

Results ALP was analysed both as a continuous variable and according to three categories. After multivariable adjustment, in-hospital mortality was significantly higher in Tertile 3 group (ALP>85 U/L) (OR: 2.399, 95% CI 1.080 to 5.333, p=0.032), compared with other two groups (Tertile 1: <66 U/L; Tertile 2: 66–85 U/L). When ALP was evaluated as a continuous variable, after multivariable adjustment, the ALP level was associated with an increased risk of in-hospital mortality (OR: 1.011, 95% CI 1.002 to 1.020, p=0.014). C-statistic of ALP for predicting in-hospital mortality was 0.630 (95% CI 0.618 to 0.642, p=0.001). The cut-off value was 72 U/L with a sensitivity of 0.764 and a specificity of 0.468. However, ALP could not significantly improve the prognostic performance of Global Registry of Acute Coronary Events (GRACE) score (GRACE score+ALP vs GRACE score: C-statistic: z=0.485, p=0.628; integrated discrimination improvement: 0.014, p=0.056; net reclassification improvement: 0.020, p=0.630).

Conclusions In patients with ACS undergoing PCI, ALP was an independent predictor of in-hospital mortality. But it could not improve the prognostic performance of GRACE score.

  • alkaline phosphatase
  • in-hospital mortality
  • acute coronary syndrome

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  • Contributors Zhaoqing Sun conceived and designed the experiments. Tongtong Yu, Yundi Jiao, Jia Song, Dongxu He, Jiake Wu, Zongyu Wen, Na Sun and Weili Duan performed the experiments. Tongtong Yu analyzed the data and wrote the paper. Zhijun Sun revised the paper. All authors had reviewed and agreed on the contents of this paper.

  • Funding This research project was supported by grants from the Social Development Research Program of Liaoning Province (2011225020).

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained

  • Ethics approval This study complies with the Declaration of Helsinki, Shengjing Hospital of China Medical University Research Ethics Committee approved the research protocol.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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