Comparison Between Soluble ST2 and High-Sensitivity Troponin I in Predicting Short-Term Mortality for Patients Presenting to the Emergency Department With Chest Pain

Abstract

Background: High-sensitivity cardiac troponin I (hs-cTnI) and the soluble isoform of suppression of tumorigenicity 2 (sST2) are useful prognostic biomarkers in acute coronary syndrome (ACS). The aim of this study was to test the short term prognostic value of sST2 compared with hs-cTnI in patients with chest pain.Methods: Assays for hs-cTnI and sST2 were performed in 157 patients admitted to the Emergency Department (ED) for chest pain at arrival. In-hospital and 30-day follow-up mortalities were assessed.Results: The incidence of ACS was 37%; 33 patients were diagnosed with ST elevation myocardial infarction (STEMI), and 25 were diagnosed with non-ST elevation myocardial infarction (NSTEMI). Compared with the no acute coronary syndrome (NO ACS) group, the median level of hs-cTnI was higher in ACS patients: 7.22 (5.24-14) pg/mL vs 68 (15.33 -163.50) pg/mL (P < 0.0001). In all patients, the sST2 level at arrival showed higher independent predictive power than hs-cTnI (odds ratio [OR] 20.13, P < 0.0001 and OR 2.61, P < 0.0008, respectively). sST2 at ED arrival showed a greater prognostic value for cardiovascular events in STEMI (area under the curve [AUC] 0.80, P < 0.001) than NSTEMI patients (AUC 0.72, P < 0.05). Overall, 51% of the STEMI patients with an sST2 value > 35 ng/mL at ED arrival died during the 30-day follow-up.Conclusions: sST2 has a greater prognostic value for 30-day cardiac mortality after discharge in patients presenting to the ED for chest pain compared with hs-cTnI. In STEMI patients, an sST2 value > 35 ng/mL at ED arrival showed the highest predictive power for short-term mortality.

Prognostic role of soluble ST2 in acute coronary syndrome with diabetes

“…Elevated levels of sST2 remained an independent predictor of MACE in the regression analysis. These observations concur with previous studies where sST2 was reported to successfully predict mortality within 30 days of emergency department admission . In another study, elevated sST2 levels were associated with increased risk of both CVD and HF .…”

“…These observations concur with previous studies where sST2 was reported to successfully predict mortality within 30 days of emergency department admission. 20 In another study, elevated sST2 levels were associated with increased risk of both CVD and HF. 21 A higher concentration of sST2 was also reported to predict long-term mortality in acute STEMI patients who underwent percutaneous coronary intervention.…”

“…A cardiac biomarker like sST2 can help in risk stratification of ACS patients with diabetes. In one of the study for prognostication of NSTEMI patients for HF and CVD, the sST2 concentration of 35 ng/mL or higher was more likely to occur in elderly male patients with diabetes . In another study, patients with MI or HF with diabetes had higher sST2 concentration compared to without diabetes patient …”

High-sensitivity troponin T and long-term adverse cardiac events among patients presenting with suspected acute coronary syndrome in Singapore

“…Alternative strategies also include investigating the use of hsTnT when used with other biomarkers, such as soluble isoform of suppression of tumorigenicity 2 (sST2), which has been shown to be useful in prognosticating 30-day cardiac mortality among ED patients with chest pain. (31) While the rise and fall of cardiac biomarkers is one of the components in the diagnosis of MI, (5) the link between delta-hsTnT and future MACE is less established. Among patients with NSTEMI, relative delta-hsTnT of 20% was linked to higher long-term mortality, and 30-day mortality was similar across quartiles of relative delta-hsTnT.…”

Novel Risk Stratification Assays for Acute Coronary Syndrome

“…ST2 can be measured using a commercially available immunoassay and is cleared by the US FDA (86). In a recent study, the prognostic value of sST2 compared with hs-cTnI was examined among sequential patients presenting to the ED with chest pain (87). Interestingly, soluble ST2 levels at time of presentation showed higher independent predictive power than hs-cTnI for cardiovascular events.…”