Prognostic Value of Soluble ST2 After Myocardial Infarction: A Community Perspective - 23/08/17
, Allan S. Jaffe, MD a, Susan A. Weston, MS b, Omar F. AbouEzzeddine, MDCM, MS a, Ruoxiang Jiang, BS b, Sheila M. Manemann, MPH b, Maurice Enriquez-Sarano, MD aAbstract |
Background |
Soluble ST2 (sST2) is a marker of cardiac mechanical strain hypothesized to adversely impact short-term prognosis after myocardial infarction. We examined the association of sST2 with longer-term outcomes after myocardial infarction in a geographically defined community.
Methods |
Olmsted County, Minnesota residents who experienced an incident (first-ever) myocardial infarction between November 1, 2002 and December 31, 2012 were prospectively enrolled; sST2 levels were measured. Patients were followed for heart failure and death.
Results |
We studied 1401 patients with incident myocardial infarction (mean age 67 years; 61% men; 79% non-ST-elevation myocardial infarction). Median sST2 (ng/mL) was 48.7 (25th-75th percentile 32.5-103.3). Soluble ST2 was elevated in 51% of patients. Higher values of sST2 were associated with increased age, female sex, and comorbidities. During 5 years of follow-up, 388 persons died and 360 developed heart failure. After adjustment for age, sex, comorbidities, Killip class, and troponin T, the hazard ratios for death were 1.73 (95% confidence interval [CI], 1.22-2.45) and 3.57 (95% CI, 2.57-4.96) for sST2 tertiles 2 and 3, respectively (Ptrend <.001). For heart failure, the hazard ratios were 1.67 (95% CI, 1.18-2.37) and 2.88 (95% CI, 2.05-4.05), respectively (Ptrend <.001). Results were similar among 30-day survivors.
Conclusions |
In the community, sST2 elevation is present in half of myocardial infarctions. Higher values of sST2 are associated with a large excess risk of death and heart failure independently of other prognostic indicators. Measurement of sST2 should be considered for risk stratification after myocardial infarction.
Le texte complet de cet article est disponible en PDF.Keywords : Heart failure, Mortality, Myocardial infarction, Soluble ST2
Plan
| Funding: This work was supported by a grant from the National Heart, Lung, and Blood Institute (NHLBI; HL120957), Bethesda, MD and The Rochester Epidemiology Project (R01-AG034676). The funding sources played no role in the design, conduct, or reporting of this study. |
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| Conflict of Interest: VLR reports grants from NHLBI, grant number HL 120957 during the conduct of the study. ASJ reports consulting from Beckman, Coulter, Siemens, Abbott, Roche, Alere, NeurogenomeX, Sphingotec, Single, and Novartis, outside the submitted work. All other authors report no conflicts of interest. |
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| Authorship: All authors had access to the data and a role in writing the manuscript. |
Vol 130 - N° 9
P. 1112.e9-1112.e15 - septembre 2017 Retour au numéro
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