Role of ST2 in non-ST-elevation acute coronary syndrome in the MERLIN-TIMI 36 trial.

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2012-01

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Abstract

Objective

We investigated the prognostic performance of ST2 with respect to cardiovascular death (CVD) and heart failure (HF) in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) in a large multinational trial.

Background

Myocytes that are subjected to mechanical stress secrete ST2, a soluble interleukin-1 receptor family member that is associated with HF after STE-ACS.

Methods

We measured ST2 with a high-sensitivity assay in all available baseline samples (N=4426) in patients enrolled in the Metabolic Efficiency With Ranolazine for Less Ischemia in the Non-ST-Elevation Acute Coronary Syndrome Thrombolysis in Myocardial Infarction 36 (MERLIN-TIMI 36), a placebo-controlled trial of ranolazine in NSTE-ACS. All events, including cardiovascular death and new or worsening HF, were adjudicated by an independent events committee.

Results

Patients with ST2 concentrations in the top quartile (>35 μg/L) were more likely to be older and male and have diabetes and renal dysfunction. ST2 was only weakly correlated with troponin and B-type natriuretic peptide. High ST2 was associated with increased risk for CVD/HF at 30 days (6.6% vs 1.6%, P<0.0001) and 1 year (12.2% vs 5.2%, P<0.0001). The risk associated with ST2 was significant after adjustment for clinical covariates and biomarkers (adjusted hazard ratio CVD/HF 1.90, 95% CI 1.15-3.13 at 30 days, P=0.012; 1.51, 95% CI 1.15-1.98 at 1 year, P=0.003), with a significant integrated discrimination improvement (P<0.0001). No significant interaction was found between ST2 and ranolazine (Pinteraction=0.15).

Conclusions

ST2 correlates weakly with biomarkers of acute injury and hemodynamic stress but is strongly associated with the risk of HF after NSTE-ACS. This biomarker and related pathway merit further investigation as potential therapeutic targets for patients with ACS at risk for cardiac remodeling.

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Journal article

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Humans, Cardiovascular Diseases, Inflammation, Acetanilides, Piperazines, Natriuretic Peptide, Brain, Receptors, Cell Surface, Electrocardiography, Prognosis, Risk Assessment, Aged, Female, Male, Heart Failure, Hemodynamics, Randomized Controlled Trials as Topic, Acute Coronary Syndrome, Biomarkers, Ranolazine, Interleukin-1 Receptor-Like 1 Protein

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https://hdl.handle.net/10161/30431

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https://creativecommons.org/licenses/by-nc/4.0

Published Version (Please cite this version)

10.1373/clinchem.2011.173369

Publication Info

Kohli, Payal, Marc P Bonaca, Rahul Kakkar, Anastacia Y Kudinova, Benjamin M Scirica, Marc S Sabatine, Sabina A Murphy, Eugene Braunwald, et al. (2012). Role of ST2 in non-ST-elevation acute coronary syndrome in the MERLIN-TIMI 36 trial. Clinical chemistry, 58(1). pp. 257–266. 10.1373/clinchem.2011.173369 Retrieved from https://hdl.handle.net/10161/30431.

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Payal Kohli

Adjunct Associate Professor in the Department of Medicine

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