Improved early risk stratification of patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention using a combination of serum soluble ST2 and NT-proBNP

Abstract

BackgroundAlthough soluble suppression of tumorigenicity 2 (sST2) in serum is known to be associated with ischemic heart disease and heart failure, data regarding its prognostic impact in ST-segment elevation myocardial infarction (STEMI) is limited. We evaluated the prognostic impacts of serum sST2 and other serum biomarkers in STEMI patients undergoing primary percutaneous coronary intervention (PCI).MethodsConsecutive all 323 patients with STEMI that underwent primary PCI were enrolled. Blood tests and samples were obtained in an emergency room. The primary endpoint was 1-year major adverse cardiovascular and cerebrovascular events (MACCEs), defined as a composite of cardiovascular death, non-fatal MI, non-fatal stroke, and ischemia-driven revascularization.ResultsMean age was 59.1±13.1 years (men 84%). MACCE (20 cardiovascular deaths, 7 non-fatal MI, 4 non-fatal stroke, 7 ischemia-driven revascularizations) occurred in 38 patients (12%). After adjusting for confounding factors, Cox regression analysis revealed that high serum sST2 (>75.8 ng/mL mean value, adjusted hazard ratio 2.098, 95% CI 1.008–4.367, p = 0.048) and high serum NT-proBNP level (>400 pg/mL, adjusted hazard ratio 2.606, 95% CI 1.086–6.257, p = 0.032) at the time of presentation independently predicted MACCE within a year of primary PCI. Furthermore, when high serum sST2 level was combined with high serum NT-proBNP level, the hazard ratio of MACCE was highest (adjusted hazard ratio 7.93, 95% CI 2.97–20.38, p<0.001).ConclusionElevated serum levels of sST2 or NT-proBNP at the time of presentation were found to predict 1-year MACCE independently and elevated serum levels of sST2 plus NT-proBNP were associated with even poorer prognosis in patients with STEMI undergoing primary PCI.

Oxidative stress and inflammation: Early predictive indicators of multiple recurrent coronary in‐stent chronic total occlusions in elderly patients after coronary stenting

“…sST2 was the new cardiovascular biomarker in the patients with acute myocardial infarction and promoted cardiomyocyte apoptosis and cardiac fibrosis. The sST2 levels were increased in patients with ST‐segment elevation myocardial infarction and sST2 levels were the new biomarkers of myocardial injury and inflammatory response in the patients with myocardial infarction, and sST2 also was the diagnostic and prognostic biomarkers of acute coronary syndrome in the patients …”

“…Our study showed that levels of TLR2, TLR3, TLR4, and sST2 were increased significantly in the elderly patients with multivessel reocclusions compared to the elderly patients with one‐ or two‐vessel reocclusions. The molecular mechanism of coronary in‐stent restenosis was strongly related to oxidative stress and inflammatory response and the increased levels of TLR2, TLR3, TLR4, and sST2 as the oxidative stress and inflammatory response biomarkers played the key roles in the patients with coronary in‐stent restenosis, and the cross talk between oxidative stress and inflammatory responses may further promoted multivessel reocclusions after coronary stenting. Our results suggested that the increased levels of TLR2, TLR3, TLR4, and sST2, and the decreased levels of EPC, SDF‐1α, VEGF, and NO could be used as the important biomarkers to reliably and early noninvasively predict multiple recurrent coronary in‐stent chronic total occlusions in the elderly patients after coronary stenting.…”

Prognostic value of soluble ST2 postaortic valve replacement: a meta-analysis

“…Of these, soluble suppression of tumorigenicity 2 (sST2), a member of the interleukin (IL)-1 receptor family, has emerged to be a promising marker of myocardial stress 7. Thus, it has been shown to be predictive of adverse clinical outcomes in different cardiovascular diseases, such as stable coronary artery disease,8 acute coronary syndrome,9 and acute10 as well as chronic heart failure 11…”

Biomarkers of Myocardial Stress and Fibrosis for Clinical Outcomes Assessment in Post Myocardial Infarction Heart Failure Patients

“…В ответ на рас-тяжение миокарда ген ST2 активируется, и его сыво-роточная концентрация быстро возрастает. Сообщается, что ST2 является предиктором СН и смерти у пациентов с ИМ с подъемом и без подъема сегмента ST [10,11], надежным биомаркером риск-стратификации пациентов с СН [12,13]. ST2 не только дополняет прогностическую ценность НП, но и явля-ется независимым предиктором [13].…”

“…В ряде крупных исследований было показано, что повышение концентрации сыво-роточного ST2 предсказывает худший прогноз у пациентов с СН [12][13][14] и пациентов с ИМ [10,11]. Ky B, et al (2012) подтвердили значение ST2 как достоверного маркера риска при хронической СН и улучшение прогностической оценки клинической шкалы риска в комбинации с NT-proBNP.…”