Prognostic significance of serum pyroptosis-related factors in acute coronary syndrome: a propensity score analysis

This study investigated the clinical significance of pyroptosis-related factors, including NLRP1, NLRP3, and HMGB1, in patients with acute coronary syndrome (ACS), and analyzed their prognostic value. A total of 231 ACS patients (unstable angina, STEMI, and NSTEMI) treated between March 2020 and August 2022 were included. Serum levels of NLRP1, NLRP3, HMGB1, IL-6, IL-1β, and CRP were measured using ELISA, and demographic and clinical data were recorded. Patients were followed for one year, and those who experienced major adverse cardiovascular events (MACE) were classified into the poor prognosis group. Propensity score matching (PSM) was applied to minimize baseline differences between groups. After PSM, 61 matched pairs (n = 122) were included for analysis, and baseline characteristics between groups were balanced. Activated partial thromboplastin time (APTT) and prothrombin time (PT) were significantly shorter in the poor prognosis group. In contrast, serum levels of NLRP1, NLRP3, and HMGB1 were significantly higher in the poor prognosis group and correlated positively with inflammatory markers. Among the factors studied, NLRP1 demonstrated the highest prognostic accuracy (AUC = 0.799, cutoff = 31.04 pg/ml, sensitivity = 70.49 %, specificity = 70.49 %). Multivariate analysis identified lower APTT and PT, as well as higher NLRP1, and NLRP3 as independent risk factors for poor prognosis. Elevated serum levels of NLRP1, NLRP3, and HMGB1 are associated with poor prognosis in patients with ACS. These factors may serve as potential biomarkers for risk stratification and therapeutic targets in clinical practice.