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Fetuin-A is an independent predictor of death after ST-elevation myocardial infarction
Pascal Lim1, Jean-Phillipe Collet, Stéphane Moutereau
1Department of Cardiology, Assistance Publique Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France. lim.pascal.hmm@gmail.com
Insights
Low plasma fetuin-A levels predict a higher risk of death in ST-elevation myocardial infarction (STEMI) patients within six months. Conversely, normal fetuin-A levels indicate an excellent survival rate, even in high-risk individuals.
Area of Science:
- Cardiology
- Biochemistry
- Clinical Medicine
Background:
- Fetuin-A is known to inhibit inflammation and protect against myocardial ischemia.
- Fetuin-A deficiency is linked to cardiovascular mortality in end-stage renal disease patients.
- The role of fetuin-A in outcomes following ST-elevation acute myocardial infarction (STEMI) requires further investigation.
Purpose of the Study:
- To investigate the association between plasma fetuin-A concentrations and clinical outcomes in patients with STEMI.
- To determine if fetuin-A levels can predict mortality at 6 months post-STEMI.
- To assess fetuin-A as a prognostic marker independent of other established risk factors.
Main Methods:
- Plasma fetuin-A was measured in 284 consecutive STEMI patients.
- Fetuin-A levels were correlated with the occurrence of death at 6 months.
- A control group was used to establish a 95th percentile cutoff for defining abnormal fetuin-A levels (140 mg/L).
Main Results:
- STEMI patients had lower mean plasma fetuin-A concentrations on admission and at day 3 compared to controls.
- Lower fetuin-A levels (<140 mg/L) at admission and day 3 were independent predictors of 6-month mortality (OR=3.3 and 6.3, respectively).
- Fetuin-A levels did not correlate with peak troponin but inversely correlated with C-reactive protein (CRP) and NT-pro-brain natriuretic peptide (NT-proBNP).
Conclusions:
- Plasma fetuin-A is a significant independent predictor of 6-month mortality in STEMI patients.
- Normal or high fetuin-A levels (> or = 140 mg/L) are associated with excellent survival rates, offering a high negative predictive value.
- Fetuin-A serves as a valuable prognostic biomarker, independent of NT-proBNP, CRP, and the CADILLAC risk score.
Background:
Fetuin-A inhibits inflammation and has a protective effect against myocardial ischemia. Its deficiency has been found to be associated with cardiovascular death in patients with end-stage renal failure disease. We investigated the association between plasma fetuin-A and clinical outcome after ST-elevation acute myocardial infarction (STEMI).
Methods:
We measured fetuin-A in 284 consecutive patients with STEMI and correlated these data with the occurrence of death at 6 months (n = 25). We also measured fetuin-A in a control group and chose the 95th percentile as the cutoff to define abnormality.
Results:
Patient mean (SD) age was 60 (14) years, and creatinine clearance was 83 (31) mL/min; 82% were men. Mean (SD) plasma fetuin-A concentrations at admission [188 (69) mg/L, P = 0.01] and at day 3 [163 (57) mg/L, P <0.0001] were lower in patients than in controls [219 (39) mg/L; 95th percentile 140 mg/L]. Fetuin-A <140 mg/L was observed in 20% of patients at admission vs 40% at day 3 (P <0.001). Fetuin-A concentrations did not correlate with peak cardiac troponin values but did correlate inversely with C-reactive protein (CRP) and NT-pro-brain natriuretic peptide (NT-proBNP). Fetuin-A <140 mg/L at admission (OR = 3.3, P = 0.03) and at day 3 (OR = 6.3, P = 0.002) was an independent correlate of death at 6 months, irrespective of NT-proBNP, CRP, or Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) risk score. Conversely, fetuin-A > or = 140 mg/L was associated with an excellent survival rate [negative predictive value (NPV) = 97% overall], even in high-risk populations with CADILLAC risk score > or = 6 (NPV = 90% in patients).
Conclusions:
Fetuin-A is an important predictor of death at 6 months in STEMI patients independent of NT-proBNP, CRP, and CADILLAC risk score.