Abstract 20145: ST2 and the Risk of CV Death or Heart Failure in Patients with Non-ST elevation Acute Coronary Syndromes (NSTE-ACS): Observations from MERLIN-TIMI 36
Abstract: ST2 is a soluble receptor for interleukin 33 (IL-33) identified by transcriptional profiling to be up-regulated by cardiomyocytes in response to mechanical strain. Elevated concentrations of ST2 in humans are associated with cardiovascular (CV) mortality in pts with heart failure (HF) and with ST-elevation myocardial infarction. We investigated the performance of ST2 for risk assessment for CV death and HF in pts presenting with NSTE-ACS.
Methods: ST2 (Critical Diagnostics) was measured in citrated plasma at baseline in 4,513 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: An ST2 concentration in the top quartile (≥ 35 ng/mL) identified pts with significantly higher rates of CV death and HF, at both 30 days and one year (Fig A). After adjustment for important covariates including age, known CAD, diabetes, HTN, dyslipidemia, smoking, history of HF, renal function, aspirin use, ST segment deviation, cTnI, and BNP, ST2 remained independently associated with the risk of CV death and HF (Fig B). There was no significant interaction with ranolazine (p=0.28). ST2 was only weakly correlated with cTnI (r=0.30) and BNP (r=0.28). The addition of ST2 to clinical factors, cTnI, and BNP resulted in a significant improvement in discrimination (IDI) for CVD and HF at 30 days (p<0.001) and 1 year (p=0.013) SPAN< SPAN<
Conclusions: ST2 was independently associated with short and long-term risk of CV death and new HF in pts with presenting with NSTE-ACS, adding to clinical predictors, cTnI, and BNP. This finding demonstrates ST2 as a candidate independent prognostic marker in pts with NSTE-ACS, and supports investigation of therapies that might modify this risk.
- © 2010 by American Heart Association, Inc.