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Background <p>Cyclophilin A (CypA) is a multifaceted immunophilin implicated in cardiovascular disease; however, its predictive value for Major Adverse Cardiac Events (MACEs) after acute myocardial injury remains poorly defined.</p> Purpose <p>The study aimed to analyze whether admission Plasma CyPA independently predicts MACEs and to assess its predictive feasibility beyond recognized clinical risk factors.</p> Method <p>In this cohort study, 217 adults with an acute myocardial injury diagnosis exhibiting symptom onset within 24 hours and high cardiac troponin 1 were included. Plasma CyPA concentrations were evaluated using enzyme-linked immunosorbent assay. Participants were closely followed up for 6 months to determine MACEs, defined as all-cause mortality, ischemic stroke, nonfatal myocardial infarction, or unexpected heart failure hospitalization. Receiver Operating Characteristic (ROC) analysis, multivariable Cox proportional hazard models, Kaplan-Meier survival curves, and calibration analysis were conducted with adjusted standard covariates.</p> Result <p>30% of participants experienced MACEs, with significantly higher CyPA concentrations among those with events than among those without (median 1.942 vs. 1.026 ng/mL; <i>p</i> &lt; 0.001). CyPA demonstrated good discriminatory ability (AUC 0.755; 95% CI: 0.680–0.830), with an optimal cutoff of 1.651 ng/mL. Higher CyPA levels were associated with significantly lower event-free survival. In multivariable analysis, CyPA remained an independent predictor of MACEs (HR 1.698; 95% CI: 1.462–1.973; <i>p</i> &lt; 0.001). The overall Brier score was 0.158, reinforcing satisfactory precision of absolute risk prediction.</p> Conclusion <p>Integration of CyPA into the baseline model significantly enhanced analytical performance, improving the C-index from 0.632 to 0.770. These conclusions suggest that CyPA may be a promising biomarker for risk stratification in acute myocardial injury and warrants external validation.</p>

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Plasma cyclophilin a as a novel predictor of major adverse cardiac events in patients with acute myocardial injury cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月29日

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  • Chaopu Zhang,
  • Wei Zhong,
  • Xiang Tang,
  • Xia Sun

摘要

Background

Cyclophilin A (CypA) is a multifaceted immunophilin implicated in cardiovascular disease; however, its predictive value for Major Adverse Cardiac Events (MACEs) after acute myocardial injury remains poorly defined.

Purpose

The study aimed to analyze whether admission Plasma CyPA independently predicts MACEs and to assess its predictive feasibility beyond recognized clinical risk factors.

Method

In this cohort study, 217 adults with an acute myocardial injury diagnosis exhibiting symptom onset within 24 hours and high cardiac troponin 1 were included. Plasma CyPA concentrations were evaluated using enzyme-linked immunosorbent assay. Participants were closely followed up for 6 months to determine MACEs, defined as all-cause mortality, ischemic stroke, nonfatal myocardial infarction, or unexpected heart failure hospitalization. Receiver Operating Characteristic (ROC) analysis, multivariable Cox proportional hazard models, Kaplan-Meier survival curves, and calibration analysis were conducted with adjusted standard covariates.

Result

30% of participants experienced MACEs, with significantly higher CyPA concentrations among those with events than among those without (median 1.942 vs. 1.026 ng/mL; p < 0.001). CyPA demonstrated good discriminatory ability (AUC 0.755; 95% CI: 0.680–0.830), with an optimal cutoff of 1.651 ng/mL. Higher CyPA levels were associated with significantly lower event-free survival. In multivariable analysis, CyPA remained an independent predictor of MACEs (HR 1.698; 95% CI: 1.462–1.973; p < 0.001). The overall Brier score was 0.158, reinforcing satisfactory precision of absolute risk prediction.

Conclusion

Integration of CyPA into the baseline model significantly enhanced analytical performance, improving the C-index from 0.632 to 0.770. These conclusions suggest that CyPA may be a promising biomarker for risk stratification in acute myocardial injury and warrants external validation.