Admission ferritin in STEMI predicts long-term major adverse cardiovascular outcomes

Inflammation is a key driver of atherosclerosis and acute coronary syndromes (ACS). Despite the prognostic relevance of inflammatory biomarkers in STEMI, the role of serum ferritin, an inflammation-sensitive marker of iron metabolism, remains unclear. The purpose of this study is to evaluate the association between elevated ferritin (≥300 ng/mL) and long-term major adverse cardiovascular events (MACE) in patients with STEMI.

This is a substudy of the PHASE-MX registry, a prospective cohort of STEMI patients treated at our institution (2018-2021). Patients ≥18 years old with ferritin measurement at admission were included. The primary outcome was MACE [all-cause mortality, cardiogenic shock, recurrent myocardial infarction, and new-onset congestive heart failure (CHF)]. A total of 477 patients were included with a follow-up of 4.5 years (median of 533 days, IQR 338-1137). Median age was 59, 45.4% had hypertension, and 34.9% had diabetes. No differences in baseline characteristics were found among groups. Ferritin ≥300 ng/mL was present in 29.9% of patients and was associated with a higher risk of MACE (HR 1.43, 95% CI 1.06-1.94; P = 0.01), driven by all-cause mortality (HR 2.00, 95% CI 1.09-3.69) and new CHF (HR 1.46, 95% CI 1.05-2.04). This association remained significant after adjustment for inflammatory markers and GRACE score (aHR 1.48, 95% CI 1.04-2.10; P = 0.02).

Elevated ferritin (≥300 ng/mL) is an independent predictor of long-term MACE in STEMI, supporting its potential role as a prognostic biomarker in ACS.