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Predictive value of HPSE for major adverse cardiovascular events in patients with ST-segment elevation myocardial
Wenyan Liu1,2, Zonghu Jia1, Bin Li1
1Department of Cardiology, The 960th Hospital of the Joint Logistics Support Force of the Chinese people's Liberation Army, Jinan, Shandong, China.
Insights
Heparanase (HPSE) levels in coronary blood predict major adverse cardiovascular events (MACE) in ST-segment elevation myocardial infarction (STEMI) patients after percutaneous coronary intervention (PCI). Elevated HPSE improves risk prediction for MACE.
Area of Science:
- Cardiology
- Biomarkers
- Myocardial Infarction
Background:
- ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI) face ongoing risks of major adverse cardiovascular events (MACE).
- Heparanase (HPSE), an enzyme involved in inflammation and vascular remodeling, is implicated in cardiovascular disease.
- The predictive value of HPSE for MACE in STEMI patients requires further investigation.
Purpose of the Study:
- To investigate the predictive capability of coronary heparanase (HPSE) levels for 6-month major adverse cardiovascular events (MACE) in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI).
- To assess whether HPSE improves the risk stratification provided by existing clinical scores like the GRACE score.
Main Methods:
- A prospective observational study involving 207 STEMI patients receiving primary PCI.
- Coronary blood samples were collected post-balloon dilation and analyzed for HPSE levels using ELISA.
- Patients were monitored for 6 months to determine the incidence of MACE.
Main Results:
- During the 6-month follow-up, 25.6% of patients experienced MACE.
- Significantly higher coronary HPSE levels were observed in patients who had MACE compared to those who did not (5.08 vs. 3.68 ng/mL, P < 0.001).
- Elevated HPSE was an independent predictor of MACE (HR=1.693, P < 0.001), and combining HPSE with the GRACE score improved MACE prediction (AUC=0.849).
Conclusions:
- Coronary HPSE is a significant independent predictor of 6-month MACE in STEMI patients post-PCI.
- HPSE enhances the predictive accuracy of the GRACE score for MACE.
- HPSE represents a promising biomarker for refining risk assessment and guiding clinical decisions in STEMI management.
Background:
Although early mortality rates have decreased following reperfusion therapies such as percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI), they remain at risk for major adverse cardiovascular events (MACE). Heparanase (HPSE) is an endogenous β-D-glucuronosidase and plays a key role in inflammation and vascular remodeling. This study investigated the predictive value of HPSE for MACE after STEMI.
Methods:
This prospective observational study included 207 consecutive STEMI patients who received primary PCI. Coronary blood was collected 10 min after balloon dilation. Coronary HPSE levels were measured by enzyme-linked immunosorbent assay (ELISA). Patients were followed for 6 months to record the occurrence of MACE.
Results:
During the 6-month follow-up period, 53 patients (25.6%) experienced MACE. Patients who experienced MACE had significantly higher coronary HPSE levels than those without (5.08 ± 1.27 ng/mL vs. 3.68 ± 1.20 ng/mL, P < 0.001). In multivariate Cox regression analysis, after adjusting for established risk factors, elevated HPSE levels remained an independent predictor of MACE (HR = 1.693, 95% CI: 1.323-2.165, P < 0.001). ROC analysis showed that a combined HPSE and GRACE model predicted MACE with an AUC of 0.849 (95% CI: 0.787-0.911, P < 0.001). Kaplan-Meier analysis revealed significantly lower MACE-free survival in the high HPSE group (log-rank P < 0.001).
Conclusion:
Coronary HPSE is an independent predictor of 6-month MACE in STEMI patients. It also enhances the predictive capability of the GRACE score. Because of this, HPSE serves as a promising biomarker that can help doctors assess risk more accurately and guide clinical decisions.
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