ESC Heart Fail. 2026 Jul 6:xvag191. doi: 10.1093/eschf/xvag191. Online ahead of print.
ABSTRACT
INTRODUCTION: Acute coronary syndrome (ACS) is frequently complicated by left ventricular systolic dysfunction and heart failure. Clonal haematopoiesis of indeterminate potential (CHIP) is characterised by mutations in haematopoietic stem cells that lead to the proliferation of mutant blood cells without overt haematological disease. Whether CHIP is associated with prognosis following ACS remains uncertain.
METHODS: We conducted a systematic review and meta-analysis of observational studies that compared outcomes after ACS in patients with and without CHIP. The primary outcome was all-cause mortality. Exploratory subgroup analyses explored mutation class and study-level comorbidities.
RESULTS: Eight studies comprising diverse ACS populations, from low-risk ACS to cardiogenic shock, were included. In the primary analysis, CHIP was associated with higher all-cause mortality (pooled HR 1.61, 95% CI 1.36-1.92), with no detected statistical heterogeneity (I2 = 0%). Mutation-specific analyses were underpowered but suggested a more consistent association between TET2 mutations and adverse events. Exploratory study-level analyses suggested that differences in smoking prevalence between CHIP carriers and non-carriers may contribute to variability in association strength, but no formal interaction testing was possible.
CONCLUSIONS: CHIP is associated with increased mortality following ACS across a broad range of clinical settings, suggesting it is a marker of adverse post-ACS risk. These findings highlight the need for adequately powered prospective studies with standardised CHIP ascertainment to determine whether CHIP represents a feasible biomarker or modifiable therapeutic target.
PMID:42406895 | DOI:10.1093/eschf/xvag191
