Homeostatic Chemokines and Prognosis in Patients With Acute Coronary Syndromes

J Am Coll Cardiol. 2019 Aug 13;74(6):774-782. doi: 10.1016/j.jacc.2019.06.030.


Background: The chemokines CCL19 and CCL21 are up-regulated in atherosclerotic disease and heart failure, and increased circulating levels are found in unstable versus stable coronary artery disease.

Objectives: The purpose of this study was to evaluate the prognostic value of CCL19 and CCL21 in acute coronary syndrome (ACS).

Methods: CCL19 and CCL21 levels were analyzed in serum obtained from ACS patients (n = 1,146) on the first morning after hospital admission. Adjustments were made for GRACE (Global Registry of Acute Coronary Events) score, left ventricular ejection fraction, pro-B-type natriuretic peptide, troponin I, and C-reactive protein levels.

Results: The major findings were: 1) those having fourth quartile levels of CCL21 on admission of ACS had a significantly higher long-term (median 98 months) risk of major adverse cardiovascular events (MACE) and myocardial infarction in fully adjusted multivariable models; 2) high CCL21 levels at admission were also independently associated with MACE and cardiovascular mortality during short-time (3 months) follow-up; and 3) high CCL19 levels at admission were associated with the development of heart failure.

Conclusions: CCL21 levels are independently associated with outcome after ACS and should be further investigated as a promising biomarker in these patients.

Keywords: CCL19; CCL21; acute myocardial infarction; prognosis; survival; unstable angina pectoris.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome / blood*
  • Acute Coronary Syndrome / diagnosis
  • Acute Coronary Syndrome / mortality
  • Aged
  • Biomarkers / blood
  • Cause of Death / trends
  • Chemokine CCL19 / blood*
  • Chemokine CCL21 / blood*
  • Echocardiography
  • Female
  • Follow-Up Studies
  • Homeostasis
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Retrospective Studies
  • Survival Rate / trends
  • Sweden / epidemiology


  • Biomarkers
  • Chemokine CCL19
  • Chemokine CCL21