Complementary roles for biomarkers of biomechanical strain ST2 and N-terminal prohormone B-type natriuretic peptide in patients with ST-elevation myocardial infarction
Complementary roles for biomarkers of biomechanical strain ST2 and N-terminal prohormone B-type natriuretic peptide in patients with ST-elevation myocardial infarction
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DOI：
10.1161/circulationaha.107.728022
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发表时间：
2008-04-15
期刊：
影响因子：
37.8
通讯作者：
Lee, Richard T.
中科院分区：
文献类型：
--
作者：
Sabatine, Marc S.;Morrow, David A.;Lee, Richard T.
背景 - ST2 是白细胞介素 1 受体家族的成员，具有可溶性形式，在对心肌细胞施加生物力学应变时其显着上调。在急性心肌梗死的情况下，循环 ST2 水平升高，但 ST2 的预测价值（独立于传统临床因素和已建立的生物力学应变生物标志物 N 末端激素原 B 型利钠肽 ( NT-proBNP)）尚未确定。 方法和结果 - 我们在 1239 名 ST 升高的患者中测量了基线 ST2 来自氯吡格雷作为辅助再灌注治疗的心肌梗塞 - 心肌梗塞溶栓 28 (CLARITY-TIMI 28) 试验。根据试验方案，患者将在 2 至 8 天后接受冠状动脉造影，并随访 30 天的临床事件。与 NT-proBNP 相比，ST2 水平独立于可能与慢性左心室壁应力增加相关的临床因素，包括年龄、高血压、既往心肌梗死和既往心力衰竭；水平也与 NT-proBNP 仅有适度相关（r = 0.14）。调整基线特征和 NT-proBNP 水平后，高于中位数的 ST2 水平与心血管死亡或心力衰竭的风险显着增加相关（第三个四分位数：调整后的比值比，1.42；95% 置信区间，0.68 至 3.57；第四个四分位数：调整后的比值比，3.57；95% 置信区间，1.87 至 6.81；趋势 P < 0.0001）。当 ST2 和 NT-proBNP 均添加到包含传统临床预测因子的模型中时，c 统计量从 0.82（95% 置信区间，0.77 至 0.87）显着改善至 0.86（95% 置信区间，0.81 至 0.90）（P = 0.017）。结论 - 在 ST 抬高型心肌梗死中，高基线 ST2 水平是心血管死亡的重要预测因子和 心力衰竭独立于基线特征和 NT-proBNP，并且 ST2 和 NT-proBNP 的组合显着改善了风险分层。这些数据强调了生物力学应变的多种互补生物标志物在 ST 段抬高型心肌梗死中的预后价值。
Background - ST2 is a member of the interleukin-1 receptor family with a soluble form that is markedly upregulated on application of biomechanical strain to cardiac myocytes. Circulating ST2 levels are elevated in the setting of acute myocardial infarction, but the predictive value of ST2 independent of traditional clinical factors and of an established biomarker of biomechanical strain, N-terminal prohormone B-type natriuretic peptide ( NT-proBNP), has not been established.Methods and Results - We measured ST2 at baseline in 1239 patients with ST-elevation myocardial infarction from the CLopidogrel as Adjunctive ReperfusIon TherapY - Thrombolysis in Myocardial Infarction 28 ( CLARITY- TIMI 28) trial. Per trial protocol, patients were to undergo coronary angiography after 2 to 8 days and were followed up for 30 days for clinical events. In contrast to NT- proBNP, ST2 levels were independent of clinical factors potentially related to chronic increased left ventricular wall stress, including age, hypertension, prior myocardial infarction, and prior heart failure; levels also were only modestly correlated with NT- proBNP ( r = 0.14). After adjustment for baseline characteristics and NT- proBNP levels, an ST2 level above the median was associated with a significantly greater risk of cardiovascular death or heart failure ( third quartile: adjusted odds ratio, 1.42; 95% confidence interval, 0.68 to 3.57; fourth quartile: adjusted odds ratio, 3.57; 95% confidence interval, 1.87 to 6.81; P < 0.0001 for trend). When both ST2 and NT- proBNP were added to a model containing traditional clinical predictors, the c statistic significantly improved from 0.82 ( 95% confidence interval, 0.77 to 0.87) to 0.86 ( 95% confidence interval, 0.81 to 0.90) ( P = 0.017).Conclusions - In ST- elevation myocardial infarction, high baseline ST2 levels are a significant predictor of cardiovascular death and heart failure independently of baseline characteristics and NT- proBNP, and the combination of ST2 and NT- proBNP significantly improves risk stratification. These data highlight the prognostic value of multiple, complementary biomarkers of biomechanical strain in ST- elevation myocardial infarction.