Prognostic Value of Soluble ST2 After Myocardial Infarction: A Community Perspective

• Published in: The American journal of medicine Vol. 130; no. 9; pp. 1112.e9 - 1112.e15
• Main Authors: Jenkins, William S., MB, BCh, Roger, Véronique L., MD, MPH, Jaffe, Allan S., MD, Weston, Susan A., MS, AbouEzzeddine, Omar F., MDCM, MS, Jiang, Ruoxiang, BS, Manemann, Sheila M., MPH, Enriquez-Sarano, Maurice, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2017
• Subjects: Age Distribution; Aged; Biomarkers - blood; Cause of Death; Comorbidity; Disease Progression; Female; Heart failure; Heart Failure - mortality; Humans; Interleukin-1 Receptor-Like 1 Protein - blood; Internal Medicine; Male; Middle Aged; Minnesota - epidemiology; Mortality; Myocardial infarction; Myocardial Infarction - blood; Myocardial Infarction - complications; Myocardial Infarction - mortality; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Prospective Studies; Risk Assessment - methods; Sex Distribution; Soluble ST2; Troponin T - blood; Heart failure; Myocardial infarction; Soluble ST2; Mortality
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/j.amjmed.2017.02.034

Abstract 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.