Abstract 12478: Fibroblast Growth Factor 23 in Acute Myocardial Infarction Complicated by Cardiogenic Shock - A Biomarker Substudy of the IABP-SHOCK II-trial
Background: The phosphaturic hormone fibroblast growth factor 23 (FGF-23) is a predictor for mortality in patients with chronic systolic heart failure. Only limited data exist regarding the prognostic relevance of FGF-23 in cardiogenic shock (CS) due to acute myocardial infarction (AMI) and its relation to kidney function has not been investigated, yet. The present study assessed the impact of FGF-23 in a large cohort of CS patients included in the randomized, IABP-SHOCK II-trial.
Methods: In IABP-SHOCK II, 600 patients with CS complicating AMI undergoing early revascularization were assigned to therapy with either IABP or no IABP. In 182 patients, blood samples collected at baseline (during primary PCI) were analysed. Immediately after sample drawing, the blood was centrifuged and the serum was frozen (-87° C). FGF-23 was measured using a standard ELISA-Kit (Teco medical, Germany). All-cause mortality at 30 days was used for outcome assessment.
Results: Patients with FGF-23 levels above the median (395.0 [IQR 102.0;2394.5] RU/mL) were characterized by an increased 30-day mortality compared to patients with FGF-23 below the median (51.6 vs. 27.5 %, p=0.002). Furthermore, they had higher levels of serum creatinine (147 [IQR 109; 208] vs. 99 [81;123] μmol/L; p≤0.001) and needed more often renal replacement therapy due to acute renal failure (30.8 vs. 11.0 %, p=0.002). In a multivariable logistic stepwise regression model including all factors with a p-value ≤ 0.1 in univariate analysis (baseline FGF-23, serum creatinine, serum lactate, age, and presence of triple vessel disease), FGF-23 remained a significant predictor for 30-day mortality (hazard ratio for 10% increase of FGF-23 2.03 [95%CI 1.34-3.07], p=0.004).
Conclusion: High FGF-23 levels are predictive for an increased short-term mortality in patients with acute myocardial infarction complicated by cardiogenic shock. This association was observed partly independently from kidney function.
- © 2013 by American Heart Association, Inc.