Abstract 5017: Osteoprotegerin and the Risk of Recurrent Events in Patients With Non-ST elevation Acute Coronary Syndromes (NSTE-ACS): Observations From MERLIN-TIMI 36
Osteoprotegerin (OPG) inhibits bone resorption and may also play a role in mediating vascular calcification. Recent studies have suggested that high plasma OPG is a strong predictor of cardiovascular disease (CV) and mortality. We hypothesized that OPG would be useful for risk assessment in patients presenting with NSTE-ACS.
METHODS: We measured OPG at baseline in 4,463 pts with NSTE-ACS randomized to ranolazine or placebo in the MERLIN-TIMI 36 trial. Patients were followed for an average of one year. Endpoints were adjudicated by a blinded CEC.
RESULTS: OPG at presentation showed a significant graded association with higher rates of recurrent CV events (Figure⇓). OPG > median (1632 pmol/L, IQR 1206–2242) was associated with a higher risk of CV death (HR 2.9; 95% CI 2.2 – 4.0), CV death or MI (HR 1.9; 95% CI 1.6 – 2.3), and CV death or CHF (HR 2.5; 95% CI 1.9 – 3.1). After adjustment for important covariates including age, gender, diabetes, smoking, HTN, index event, cTnI, CRP and BNP, OPG remained independently associated with the risk of death (adj HR 1.7; 95% CI 1.2 – 2.4), CVD or MI (adj HR 1.4; 95% CI 1.1 – 1.7) and CVD or CHF (adj HR 1.4; 95% CI 1.1 – 1.8).
CONCLUSIONS: OPG was independently associated with long-term risk of recurrent CV events in patients with NSTE-ACS, adding to clinical predictors, cTnI, CRP and BNP. This finding in a large data set adds to the emerging evidence supporting OPG as a candidate prognostic marker in pts with ACS, and supports investigation of other therapies that might modify this risk.