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Published on: January 28, 2020
Soluble ST2 in plasma is associated with post-procedural no-or-slow reflow after primary percutaneous coronary
Frederik T Søndergaard1, Rasmus P Beske1, Martin Frydland1
1Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej, Copenhagen 9 DK-2100, Denmark.
Insights
Pre-procedural soluble suppression of tumourigenicity 2 (sST2) levels predict no-or-slow-reflow after ST-elevation myocardial infarction (STEMI) interventions. Higher sST2 indicates increased risk of this complication and associated mortality.
Area of Science:
- Cardiology
- Biomarkers
- Interventional Cardiology
Background:
- The no-or-slow-reflow phenomenon complicates primary percutaneous coronary intervention in ST-elevation myocardial infarction (STEMI).
- Elevated plasma soluble suppression of tumourigenicity 2 (sST2) levels in early STEMI correlate with adverse outcomes like mortality and heart failure.
Purpose of the Study:
- To investigate the association between pre-intervention plasma sST2 levels and the occurrence of post-procedural no-or-slow-reflow in STEMI patients.
Main Methods:
- A cohort of 1607 STEMI patients undergoing primary percutaneous coronary intervention were analyzed.
- Pre-intervention plasma sST2 levels were measured upon admission before coronary angiography.
- Post-procedural coronary flow was assessed using the Thrombolysis in Myocardial Infarction (TIMI) classification, with TIMI 0-2 defined as no-or-slow reflow.
Main Results:
- No-or-slow reflow occurred in 5.4% of patients and was associated with higher 30-day mortality (11% vs. 4.3%).
- Patients with no-or-slow reflow exhibited significantly higher pre-procedural sST2 levels (median 47 ng/mL vs. 39 ng/mL, P < 0.001).
- Pre-procedural sST2 was independently associated with no-or-slow reflow (OR 1.44 per two-fold increase, P = 0.0012).
Conclusions:
- Pre-procedural plasma sST2 levels are an independent predictor of the no-or-slow-reflow phenomenon following primary PCI in STEMI.
- sST2 may serve as a valuable biomarker for identifying STEMI patients at risk for impaired coronary reperfusion.
Aim:
The no-or-slow-reflow phenomenon after primary percutaneous coronary intervention is associated with more extensive myocardial injury in patients with ST-elevation myocardial infarction (STEMI). Soluble suppression of tumourigenicity 2 (sST2) is released in acute myocardial response to injury, and an increase in plasma level in the initial phase of STEMI is associated with increased mortality and risk of heart failure. We have therefore explored the association of pre-intervention plasma sST2 with the post-procedural no-or-slow-reflow phenomenon in patients with STEMI.
Methods And Results:
We included consecutive patients with verified STEMI from two tertiary heart centres. Blood samples were collected at admission before angiography. Post-procedural coronary flow was assessed according to thrombolysis in myocardial infarction (TIMI) classification for STEMI. Patients were divided into two groups: post-procedural TIMI 0-2 as no-or-slow reflow and TIMI 3 as normal reflow. The association between sST2 and TIMI flow was explored using multiple logistic regression. A total of 1607 patients with available TIMI flow classification were included in the analysis. Normal reflow was seen in 1520 (94.6%), while 87 (5.4%) had no-or-slow reflow. No-or-slow-reflow patients had higher all-cause 30-day mortality [10 (11%) vs. 65 (4.3%), P = 0.006]. Pre-procedural sST2 was higher in the no-or-slow-flow group [47 ng/mL, interquartile range (IQR, 33-83) vs. 39 ng/mL (IQR 29-55), P < 0.001] and was independently associated with post-procedural no-or-slow flow [two-fold sST2 increase: odds ratio 1.44 (1.15-1.78), P = 0.0012].
Conclusion:
In patients with STEMI, the sST2 level at admission before coronary angiography is independently associated with the post-procedural no-or-slow-reflow phenomenon.
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