Influence of Serum Apelin and CD40L Expression Levels on Adverse Cardiovascular Events after PCI


  • Jie Zhang Department of Cardiology, Jingzhou First People's Hospital, The First Affiliated Hospital of Yangtze University, 434000 Jingzhou, Hubei, China
  • Yanjun Liu Department of Cardiovascular Ward III, Xiantao First People's Hospital, 433000 Xiantao, Hubei, China
  • Ning Liu Department of Cardiovascular Ward III, Xiantao First People's Hospital, 433000 Xiantao, Hubei, China



percutaneous coronary intervention, adipokines, type II transmembrane glycoprotein, adverse cardiovascular event, influencing factors


Objective: This study aimed to investigate the effects of serum levels of apelin and CD40L on major adverse cardiovascular events (MACEs) after percutaneous coronary intervention (PCI). Methods: A case–control study was conducted to select patients undergoing PCI in our hospital from June 2020 to June 2022. Patients were divided into the occurrence group and the non-occurrence group according to whether MACEs occurred during the 12-month follow-up after surgery. Enzyme-linked immunosorbent assay was used to detect the expression levels of serum apelin and CD40L in the two groups, and the correlation between the expression of apelin and CD40L and prognosis was analyzed. Logistic regression analysis was performed on the indicators with differences to analyze the influencing factors of the prognosis of PCI. Results: Compared with the non-occurrence group, the occurrence group had a significantly lower level of apelin and a significantly higher level of CD40L (p < 0.001). Apelin was negatively correlated with the occurrence of MACEs after PCI (r = –0.583, p < 0.001), and CD40L was positively correlated with the occurrence of MACEs after PCI (r = 0.569, p < 0.001). Logistic regression analysis showed that apelin was a protective factor for MACEs after PCI (odds ratio (OR) = 0.248, p < 0.001); CD40L, age, hypertension, and the number of diseased vessels were risk factors for MACEs after PCI (OR = 8.684, 0.018, 0.003, 0.020, p < 0.05). The area under curve (AUC) of apelin combined with CD40L was large, and the predictive value was higher than that of apelin and CD40L alone (AUC values were 0.956, 0.857, 0.905, p < 0.001; p < 0.001; p < 0.001). Conclusions: This study showed that the levels of apelin and CD40L were correlated with MACEs after PCI. Clinicians should pay close attention to the levels of apelin and CD40L in patients after PCI and be alert to the occurrence of MACEs.

Author Biography

Yanjun Liu, Department of Cardiovascular Ward III, Xiantao First People's Hospital, 433000 Xiantao, Hubei, China

Department of Cardiovascular Ward III


Sethi NJ, Safi S, Korang SK, Hróbjartsson A, Skoog M, Gluud C, et al. Antibiotics for secondary prevention of coronary heart disease. The Cochrane Database of Systematic Reviews. 2021; 2: CD003610.

Ingebrigtsen TS, Marott JL, Vestbo J, Nordestgaard BG, Lange P. Coronary heart disease and heart failure in asthma, COPD and asthma-COPD overlap. BMJ Open Respiratory Research. 2020; 7: e000470.

Chen X, Wang R, Chen W, Lai L, Li Z. Decoy receptor-3 regulates inflammation and apoptosis via PI3K/AKT signaling pathway in coronary heart disease. Experimental and Therapeutic Medicine. 2019; 17: 2614–2622.

Enas EA, Varkey B, Dharmarajan TS, Pare G, Bahl VK. Lipoprotein(a): An underrecognized genetic risk factor for malignant coronary artery disease in young Indians. Indian Heart Journal. 2019; 71: 184–198.

Reynolds HR, Bairey Merz CN, Berry C, Samuel R, Saw J, Smilowitz NR, et al. Coronary Arterial Function and Disease in Women with No Obstructive Coronary Arteries. Circulation Research. 2022; 130: 529–551.

Ozaki Y, Hara H, Onuma Y, Katagiri Y, Amano T, Kobayashi Y, et al. CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) update 2022. Cardiovascular Intervention and Therapeutics. 2022; 37: 1–34.

Tabrizi AT, Moghaddasi H, Rabiei R, Sharif-Kashani B, Nazemi AE. Development of a Catheterization and Percutaneous Coronary Intervention Registry with a Data Management Approach: A Systematic Review. Perspectives in Health Information Management. 2019; 16: 1b.

Kassimis G, Karamasis GV, Katsikis A, Abramik J, Kontogiannis N, Didagelos M, et al. Should Percutaneous Coronary Intervention be the Standard Treatment Strategy for Significant Coronary Artery Disease in all Octogenarians? Current Cardiology Reviews. 2021; 17: 244–259.

Urban P, Mehran R, Colleran R, Angiolillo DJ, Byrne RA, Capodanno D, et al. Defining high bleeding risk in patients undergoing percutaneous coronary intervention: a consensus document from the Academic Research Consortium for High Bleeding Risk. European Heart Journal. 2019; 40: 2632–2653.

Park S, Park SJ, Park DW. Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Revascularization of Left Main Coronary Artery Disease. Korean Circulation Journal. 2023; 53: 113–133.

Park S, Park SJ, Park DW. Percutaneous Coronary Intervention for Left Main Coronary Artery Disease: Present Status and Future Perspectives. JACC Asia. 2022; 2: 119–138.

Rozwadowski J, Borodzicz-Jażdżyk S, Czarzasta K, Cudnoch-Jędrzejewska A. A Review of the Roles of Apelin and ELABELA Peptide Ligands in Cardiovascular Disease, Including Heart Failure and Hypertension. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. 2022; 28: e938112.

Bosmans LA, Bosch L, Kusters PJH, Lutgens E, Seijkens TTP. The CD40-CD40L Dyad as Immunotherapeutic Target in Cardiovascular Disease. Journal of Cardiovascular Translational Research. 2021; 14: 13–22.

Askin L, Askin HS, Tanrıverdi O, Ozyildiz AG, Duman H. Serum apelin levels and cardiovascular diseases. Northern Clinics of Istanbul. 2022; 9: 290–294.

Chapman FA, Maguire JJ, Newby DE, Davenport AP, Dhaun N. Targeting the apelin system for the treatment of cardiovascular diseases. Cardiovascular Research. 2023; 119: 2683–2696.

Daub S, Lutgens E, Münzel T, Daiber A. CD40/CD40L and Related Signaling Pathways in Cardiovascular Health and Disease-The Pros and Cons for Cardioprotection. International Journal of Molecular Sciences. 2020; 21: 8533.

Shami A, Edsfeldt A, Bengtsson E, Nilsson J, Shore AC, Natali A, et al. Soluble CD40 Levels in Plasma Are Associated with Cardiovascular Disease and in Carotid Plaques with a Vulnerable Phenotype. Journal of Stroke. 2021; 23: 367–376.

Gergei I, Kälsch T, Scharnagl H, Kleber ME, Zirlik A, März W, et al. Association of soluble CD40L with short-term and long-term cardiovascular and all-cause mortality: The Ludwigshafen Risk and Cardiovascular Health (LURIC) study. Atherosclerosis. 2019; 291: 127–131.

França TT, Al-Sbiei A, Bashir G, Mohamed YA, Salgado RC, Barreiros LA, et al. CD40L modulates transcriptional signatures of neutrophils in the bone marrow associated with development and trafficking. JCI Insight. 2021; 6: e148652.

Yongguang G, Yibing S, Ping X, Jinyao Z, Yufei F, Yayong H, et al. Diagnostic efficacy of CCTA and CT-FFR based on risk factors for myocardial ischemia. Journal of Cardiothoracic Surgery. 2022; 17: 39.

Akbari H, Hosseini-Bensenjan M, Salahi S, Moazzen F, Aria H, Manafi A, et al. Apelin and its ratio to lipid factors are associated with cardiovascular diseases: A systematic review and meta-analysis. PLoS ONE. 2022; 17: e0271899.

Kucukosmanoglu M, Sahin S, Urgun OD, Yildirim A, Kilic S, Sen O, et al. The Impact of Transcatheter Aortic Valve Implantation (TAVI) on Serum Apelin Levels in Patients with Aortic Valvular Stenosis. Brazilian Journal of Cardiovascular Surgery. 2021; 36: 372–378.

Guo S, Luo X, Huang L, Wang C, Yang Y, Yang L. Hot spots and trends in PCI prognostic research: A bibliometric analysis with CiteSpace. Medicine. 2023; 102: e35599.

Kojok K, Akoum SE, Mohsen M, Mourad W, Merhi Y. CD40L Priming of Platelets via NF-κB Activation is CD40- and TAK1-Dependent. Journal of the American Heart Association. 2018; 7: e03677.

Mughal A, Sun C, OʼRourke ST. Apelin Reduces Nitric Oxide-Induced Relaxation of Cerebral Arteries by Inhibiting Activation of Large-Conductance, Calcium-Activated K Channels. Journal of Cardiovascular Pharmacology. 2018; 71: 223–232.

Zhao E, Xie H, Zhang Y. A Nomogram Based on Apelin-12 for the Prediction of Major Adverse Cardiovascular Events after Percutaneous Coronary Intervention among Patients with ST-Segment Elevation Myocardial Infarction. Cardiovascular Therapeutics. 2020; 2020: 9416803.

Bosmans LA, van Tiel CM, Aarts SABM, Willemsen L, Baardman J, van Os BW, et al. Myeloid CD40 deficiency reduces atherosclerosis by impairing macrophages' transition into a pro-inflammatory state. Cardiovascular Research. 2023; 119: 1146–1160.

Kłósek M, Sędek Ł, Lewandowska H, Czuba ZP. The effect of ethanolic extract of Brazilian green propolis and artepillin C on aFGF-1, Eselectin, and CD40L secreted by human gingival fibroblasts. Central-European Journal of Immunology. 2021; 46: 438–445.

Liu Z, Xiang Q, Mu G, Xie Q, Zhou S, Wang Z, et al. Effectiveness and Safety of Platelet ADP -P2Y12 Receptor Inhibitors Influenced by Smoking Status: A Systematic Review and Meta-Analysis. Journal of the American Heart Association. 2019; 8: e010889.

d'Entremont MA, Yagi R, Salia SJS, Zhang S, Shaban L, Bene-Alhasan Y, et al. The effect of diabetes on surgical versus percutaneous left main revascularization outcomes: a systematic review and meta-analysis. Journal of Cardiothoracic Surgery. 2022; 17: 61.

Poredos P, Blinc A, Novo S, Antignani PL. How to manage patients with polyvascular atherosclerotic disease. Position paper of the International Union of Angiology. International Angiology. 2021; 40: 29–41.



How to Cite

Zhang, J., Liu, Y., & Liu, N. (2024). Influence of Serum Apelin and CD40L Expression Levels on Adverse Cardiovascular Events after PCI. The Heart Surgery Forum, 27(6), E582-E588.