Abstract 3481: Prognostic Utility of Serial Measurements of a Novel Biomarker ST2 in Stemi Patients Treated With Primary PCI
Background: ST2 is a novel marker with prognostic value in acute heart failure and ST-elevation acute myocardial infarction (STEMI) treated with fibrinolysis. We evaluated the dynamic and prognostic utility of serial ST2 measurements in unselected group of STEMI patients treated with primary angioplasty (PCI).
Methods: ST2 levels were obtained at baseline, 6, 12, 18, 24 and 48 hours from admission in 68 consecutive patients. Association between serial ST2 levels and mortality at 1.5 years was established.
Results: Median ST2 levels were 0.13; 0.23; 0.13; 0.12; 0.09; 0.06 ng/ml respectively, at baseline, 6, 12, 18, 24 and 48 hours from admission, with statistically significant decrease at 12 hours. There were 9 deaths. Median ST2 values were significantly higher among decedents than survivors at each time of sampling up to 24 hour (Figure⇓). ROC analyses demonstrated an AUC of 0.72; 0.87; 0.91; 0.78; 0.79 and 0.76 (p<0.05 for all) for ST2 and death at 1.5 years. When divided by survival status, decedents showed a significant ST2 increase up to 12 hours from presentation with the steepest rise between 6 –12 hours, a finding not observed among survivors (Figure⇓). In multivariate analysis ST2 increase from 0 to 12 hour by 2.8-fold was an independent predictor of death at 1.5 years (HR=23.0, 95% confidence interval 2.9 –189.3, p=0.004) while increase of ST2 levels between 6 to 12 hours also was an independent predictor of death (HR=8.5, 95% confidence interval 1.4 –52.5, p=0.02).
Conclusions: Among those with acute STEMI treated with PCI, elevated ST2 levels are associated with higher long-term mortality, particularly when rapid increase of ST2 levels is observed.