Objectives DKK-1, a major regulator of the wingless (Wnt) pathway, turns out to play role in cardiovascular disease. The knowledge of relationship between DKK-1 and ACS is limited, and we also want to find whether the predictive value of post-discharge GRACE risk score can be improved by adding DKK-1.

Methods 291 patients admitted in our cardiovascular department from March 2008 to January 2010 were enrolled (46 with STEMI and 245 with NSTE-ACS) in the study. All the clinical data were collected by a specific physician. The plasma DKK-1 concentrations were measured using ELISA (R&D) strictly according to the manufacturer's protocol. We calculated the post-discharge GRACE score and assessed the prognostic value alone and together with DKK-1 or hs-CRP.

Results After a median follow-up of 2 years, 40 patients had major adverse cardiac event. DKK-1 was significantly higher in STEMI patients compared with NSTE-ACS patients in baseline (p=0.006). The concentration of DKK-1 was higher in the high risk category of GRACE score than the intermediate and low groups (p=0.006 and p<0.001). There was no significant difference between the intermediate and low groups (p=0.099). The event group also had higher DKK-1 concentration compared with non-event group (p<0.001). DKK-1 concentration was correlated with hs-CRP (r=0.295, p<0.001). The GRACE score provided a c-statistic regarding MACE of 0.523. The c-statistic was improved to 0.782 after addition of hs-CRP, 0.768 for DKK-1 and 0.834 when both two biomarkers were added.

Conclusions DKK-1 is an independent predictor for long-term MACE of ACS patients. The long-term predictive ability of post-discharge GRACE score is enhanced by the addition of DKK-1.