Periprocedural 24-Hour Change in Renalase Adds Incremental Value for Early Risk Stratification of Cardiovascular...

Renalase, a stress-responsive enzyme with cardioprotective effects, exhibits a postreperfusion surge that temporally parallels the maturation of microvascular obstruction (MVO). We investigated whether the periprocedural change in renalase (Δ-renalase) is independently associated with MVO after primary percutaneous coronary intervention (PPCI).

This prospective cohort study enrolled 266 consecutive patients with ST-segment-elevation myocardial infarction within 12 hours of symptom onset undergoing PPCI at the Third Xiangya Hospital (August 2024 to July 2025). Serum renalase was measured before and 24 hours after PPCI. Cardiovascular magnetic resonance performed 2 to 5 days after PPCI was used to define MVO. All enrolled patients were followed for 90 days after hospital discharge.

The cohort had a mean age of 60.1 years, and 31.6% were women. MVO was identified in 118 patients (44.4%). In univariable analysis, Δ-renalase showed a significant overall association with MVO (P=0.002) without evidence of nonlinearity (P=0.743). After adjustment for a prespecified 9-covariate set, Δ-renalase was modeled using restricted cubic splines and showed an independent, nonlinear association with MVO (overall P=0.002; nonlinear P=0.001). MVO odds increased more steeply at Δ-renalase values >0 μg/mL. Adding Δ-renalase improved discrimination (Δ area under the receiver operating characteristic curve=0.045), overall accuracy (Brier score 0.214-0.197), and net benefit across 30% to 50% risk thresholds. Higher Δ-renalase was independently associated with greater infarct extent (% left ventricular mass) and, among patients with cardiovascular magnetic resonance-defined MVO, greater MVO extent (% left ventricular mass), as well as lower 90-day peak oxygen pulse. Sensitivity analyses were consistent, with no significant effect modifications.

In patients with ST-segment-elevation myocardial infarction treated with PPCI, periprocedural Δ-renalase is independently associated with cardiovascular magnetic resonance-defined MVO and improves risk stratification, supporting its potential for early risk prediction.

URL: https://www.clinical.trials.gov; Unique Identifier: NCT06669520.