Abstract 18417: Syndecan-1 and Heparan Sulfate in Acute Myocardial Infarction Complicated by Cardiogenic Shock - A Biomarker Substudy of the IABP-SHOCK II-Trial
Introduction: In cardiogenic shock (CS) pathophysiological changes include microcirculatory and endothelial dysfunction. The endothelial glycocalyx is a central modulator of these processes. The glycosaminoglycan heparan sulfate (HS) is a major component of the glycocalyx and syndecan-1 (S1) represents the most prevalent proteoglycan.
Hypothesis: Aim of the current study was to investigate their role in infarct-related CS to evaluate the predictive value of these markers on outcome and the influence of the intra-aortic balloon pump (IABP) on the glycocalyx due to its influence on pulsatility.
Methods: In IABP-SHOCK II, 600 patients with CS complicating acute myocardial infarction undergoing early revascularization were assigned to therapy with either IABP or no IABP. In 184 patients, blood samples collected at baseline and after one day were analyzed. Immediately after sample drawing, the blood was centrifuged and the serum frozen (-87° C). HS and S1 were measured using standard ELISA-kits. All-cause mortality at 30 days was used for outcome assessment.
Results: Survivors at 30 days had lower baseline S1 levels (233 [95-701] vs. 553 [288-1592] ng/mL; p<0.001) and a strong trend to lower HS levels (2.1 [0.3-6.3] vs. 2.8 [0.7-7.1] mg/mL; p=0.052). On day 1 differences in S1 sustained (136 [38-485] vs. 434 [192-1183] ng/mL; p<0.001), whereas HS levels were equal (6.6 [3.1-11.3] vs. 9.2 [4.8-12.6] mg/mL; p=0.12). Patients with S1 but bot HS levels above the median had worse outcome in Kaplan-Meier-analysis (S1: HR 2.46 [95%CI 1.55-3.90], p<0.001; HS HR 1.29 [95%CI 0.81-2.04], p=0.27). After multivariable adjustment S1 remained an independent predictor of 30-day mortality (OR per μg/mL 2.2 [95%CI 1.30-3.58], p=0.003) together with serum lactate, age, and ejection fraction. Patients randomized to IABP had no difference in HS levels, but significant higher S1 levels at day 1 (IABP vs. control 303 [107-712] vs. 139 [34-492] ng/mL; p=0.01).
Conclusions: High S1 levels are predictive for an increased short-term mortality in patients with infarct-related cardiogenic shock. This association was not observed for HS. In patients randomized to IABP S1 levels on day 2 were significantly higher than in controls indicating a potential adverse effect of IABP therapy.
Author Disclosures: G. Fuernau: None. C. Jung: None. P. Muench: None. S. Desch: None. I. Eitel: None. G. Schuler: None. V. Adams: None. H.R. Figulla: None. H. Thiele: None.
- © 2014 by American Heart Association, Inc.