Serum Levels of the Interleukin-1 Receptor Family Member ST2 Predict Mortality and Clinical Outcome in Acute Myocardial Infarction

Abstract

Background-Mechanically overloaded cardiomyocytes secrete a soluble interleukin-1 receptor family member called ST2. Serum levels of ST2 are associated with prognosis in nonischemic heart failure, but the predictive value of ST2 in patients with acute myocardial infarction is unknown. In an analysis of outcomes at 30 days by ST2 quartiles, both death (Pϭ0.001) and the combined death/heart failure end point (Pϭ0.001) showed a significant graded association with levels of ST2; furthermore, in-hospital death (Pϭ0.003) and death/heart failure (Pϭ0.004) were also significantly associated with higher ST2 levels. In a logistic regression analysis that controlled for important clinical factors, increasing levels of ST2 remained associated with death at 30 days (Pϭ0.047). ST2 levels rose during the first day after infarction and were maximal at 12 hours; ST2 levels at 12 hours were also independently associated with death at 30 days (PϽ0.001). Conclusions-Serum levels of the interleukin-1 receptor family member ST2 predict mortality and heart failure in patients with acute myocardial infarction. These data suggest that ST2 may be a useful biomarker and that this novel inflammatory receptor may play a role in cardiac pathophysiology.

Soluble ST2 predicts outcome and hemorrhagic transformation after acute stroke

“…Circulating sST2 was previously identified as a prognostic marker in heart failure and myocardial infarction 7, 8, 9, 24. Together with other cardiac biomarkers such as troponin25 and B‐type natriuretic peptide (BNP),26, 27 our data highlight overlapping injury responses that occur following both cerebrovascular and cardiovascular injury.…”

“…Previous studies have identified sST2 as a prognostic biomarker in cardiovascular disease 7, 8, 9. In order to exclude the possibility that the association between sST2 and outcome was related to underlying cardiovascular disease, we developed sequential multivariable models that included cardiovascular disease risk factors.…”

“…A soluble form (sST2) is secreted into the circulation and functions as a decoy receptor for IL‐33, inhibiting its signaling 6. Circulating levels of sST2 are associated with adverse outcome and mortality in patients with chronic heart failure (CHF) and myocardial infarction (MI) 7, 8, 9. Recently, higher sST2 has been associated with an elevated risk of incident stroke 10…”

Biomarkers of apoptosis, inflammation, and cardiac extracellular matrix remodelling in the prognosis of heart failure

“…sST2 levels were measured in serum from 810 patients in the Thrombolysis In Myocardial Infarction (TIMI) 14 study (362 patients) and the TIMI-23 study (448 patients); both compared different anticoagulation strategies in patients after acute MI with ST segment elevation [46]. Baseline levels of sST2 were significantly higher in patients who died or developed congestive HF within 30 days.…”

Randomised Assessment of Treatment using Panel Assay of Cardiac markers – Contemporary Biomarker Evaluation (RATPAC CBE)

“…135 IL-33/ST2 signalling is a mechanically activated, cardioprotective fibroblast-cardiomyocyte paracrine system. 136,137 ST2 is elevated following myocardial infarction 138 and elevated levels predict an adverse outcome independently of NTproBNP. 139 The role appears to be predominantly prognostic, 140 but a role in the emergency department population has been questioned, 141 as has the concept of additional risk prediction over current markers.…”