Circulating beta-hydroxybutyrate levels are associated with major adverse clinical events in patients with acute myocardial infarction

Abstract Background Acute myocardial infarction (AMI) is associated with high mortality, and effective biomarkers are required for the risk stratification of patients with AMI. In cardiovascular diseases, circulating levels of ketone bodies (KB) such as beta-hydroxybutyrate (BHB) and acetoacetate are altered. However, the relationship between circulating KB levels and major adverse clinical events (MACE) in patients with ST-elevation myocardial infarction (STEMI) is unknown. Methods Patients with STEMI undergoing percutaneous coronary intervention (PCI) between January 2010 to June 2020 were enrolled, and divided into T1 (< 0.09 mmol/L, n=219), T2 (0.09-0.28 mmol/L, n=202), and T3 (> 0.28 mmol/L, n=211) tertiles according to the circulating BHB levels within 24 h of admission. The primary endpoint was in-hospital MACE, including all-cause mortality, stroke, recurrence of AMI, or target vessel revascularization. Results The incidence of in-hospital MACE in the T3 group (20.9%) was significantly higher than in the T1 group (10.5%) and T2 group (14.9%) (P=0.012). Multivariate logistic regression analysis showed that elevated circulating BHB levels were associated with an increased risk of all-cause mortality and MACE during hospitalization (OR = 1.41, 95% CI = 1.08-1.85, P = 0.012). During follow-up period, multivariate Cox regression analyses showed that elevated circulating BHB levels were associated with higher all-cause mortality and MACE (OR = 1.36, 95% CI = 1.19-1.56, P < 0.001). The impact of BHB on MACE were similar for all the subgroups. Conclusion Elevated circulating BHB levels within 24 h of admission were associated with an increased risk of MACE in patients with STEMI undergoing PCI, and could be a promising prognosis biomarker.