Abstract 16701: Prognostic Impact of Increased Angiopoietin-2 in Acute Myocardial Infarction Complicated by Cardiogenic Shock - A Biomarker Substudy of the IABP-SHOCK II-Trial
Background: Endothelial leakage is a key factor in the pathophysiology of cardiogenic shock (CS). Angiopoietin-2 (Ang-2) impairs endothelial integrity and has negative prognostic impact in CS complicating acute myocardial infarction (AMI). The aims of the present study were to investigate the prognostic role of Ang-2, to define clinical predictors of increased Ang-2, and to assess the impact of the presence of IABP support in patients included in the randomized IABP-SHOCK II-trial.
Methods: In IABP-SHOCK II, 600 patients with CS undergoing early revascularization were randomized to therapy with either IABP or no IABP. No differences were observed regarding the primary endpoint 30-day mortality. In 149 patients surviving until day 3, blood samples were collected directly at randomization (day 1), on day 2 and day 3. Immediately after sample drawing, blood was centrifuged and the serum was frozen (-87°C). Ang-2 was measured with a standardized ELISA-Kit.
Results: In total, 41 out of 149 patients (27.5%) died within 30 days. Compared to survivors (S), non-survivors (NS) had higher Ang-2 concentrations at all time points (median [IQR] day 1: 6.5 [5.4; 8.4] vs. 4.3 [3.8; 5.0]; day 2: 10.8 [7.4; 16.7] vs. 5.2 [4.2; 5.9]; day 3: 13.3 [8.8; 18.1] vs. 5.9 [4.9; 7.1] μg/ml; p<0.0001 for all] and exhibited a stronger increase over time (p<0.001). The presence of IABP support did not influence Ang-2 concentrations.
In ROC analysis, the power of Ang-2 to predict 30-day mortality significantly increased over time (Area under the curve [AUC) day 1: 0.67; day 3: 0.77; p=0.02). Clinical characteristics significantly predicting increased Ang-2 concentrations in multivariate analysis were serum lactate, creatinine, history of peripheral artery disease, previous stroke, and absence of TIMI-III flow. The prognostic role of Ang-2 concentrations above the median remained significant in multivariate analysis adjusted for these factors (HR per 10% increase 27.4 [CI 7.1-106.3]).
Conclusions: In patients with CS complicating AMI Ang-2 concentrations at different time points were independent predictors for 30-day mortality. Several clinical characteristics associated with increased Ang-2 levels were identified. The presence of IABP had no influence on Ang-2 levels.
- © 2013 by American Heart Association, Inc.