Comparison Between Soluble ST2 and High-Sensitivity Troponin I in Predicting Short-Term Mortality for Patients Presenting to the Emergency Department With Chest Pain
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Background: High-sensitivity cardiac troponin I (hs-cTnI) and the soluble isoform of suppression of tumorigenicity 2 (sST2) are useful prognostic biomarkers in acute coronary syndrome (ACS). The aim of this study was to test the short term prognostic value of sST2 compared with hs-cTnI in patients with chest pain. Methods: Assays for hs-cTnI and sST2 were performed in 157 patients admitted to the Emergency Department (ED) for chest pain at arrival. In-hospital and 30-day follow-up mortalities were assessed. Results: The incidence of ACS was 37%; 33 patients were diagnosed with ST elevation myocardial infarction (STEMI), and 25 were diagnosed with non-ST elevation myocardial infarction (NSTEMI). Compared with the no acute coronary syndrome (NO ACS) group, the median level of hs-cTnI was higher in ACS patients: 7.22 (5.24-14) pg/mL vs 68 (15.33 -163.50) pg/mL (P<0.0001). In all patients, the sST2 level at arrival showed higher independent predictive power than hs-cTnI (odds ratio [OR] 20.13, P<0.0001 and OR 2.61, P<0.0008, respectively). sST2 at ED arrival showed a greater prognostic value for cardiovascular events in STEMI (area under the curve [AUC] 0.80, P<0.001) than NSTEMI patients (AUC 0.72, P<0.05). Overall, 51% of the STEMI patients with an sST2 value>35 ng/mL at ED arrival died during the 30-day follow-up. Conclusions: sST2 has a greater prognostic value for 30-day cardiac mortality after discharge in patients presenting to the ED for chest pain compared with hs-cTnI. In STEMI patients, an sST2 value >35 ng/mL at ED arrival showed the highest predictive power for short-term mortality.
Abstract
Background: High-sensitivity cardiac troponin I (hs-cTnI) and the soluble isoform of suppression of tumorigenicity 2 (sST2) are useful prognostic biomarkers in acute coronary syndrome (ACS). The aim of this study was to test the short term prognostic value of sST2 compared with hs-cTnI in patients with chest pain. Methods: Assays for hs-cTnI and sST2 were performed in 157 patients admitted to the Emergency Department (ED) for chest pain at arrival. In-hospital and 30-day follow-up mortalities were assessed. Results: The incidence of ACS was 37%; 33 patients were diagnosed with ST elevation myocardial infarction (STEMI), and 25 were diagnosed with non-ST elevation myocardial infarction (NSTEMI). Compared with the no acute coronary syndrome (NO ACS) group, the median level of hs-cTnI was higher in ACS patients: 7.22 (5.24-14) pg/mL vs 68 (15.33 -163.50) pg/mL (P<0.0001). In all patients, the sST2 level at arrival showed higher independent predictive power than hs-cTnI (odds ratio [OR] 20.13, P<0.0001 and OR 2.61, P<0.0008, respectively). sST2 at ED arrival showed a greater prognostic value for cardiovascular events in STEMI (area under the curve [AUC] 0.80, P<0.001) than NSTEMI patients (AUC 0.72, P<0.05). Overall, 51% of the STEMI patients with an sST2 value>35 ng/mL at ED arrival died during the 30-day follow-up. Conclusions: sST2 has a greater prognostic value for 30-day cardiac mortality after discharge in patients presenting to the ED for chest pain compared with hs-cTnI. In STEMI patients, an sST2 value >35 ng/mL at ED arrival showed the highest predictive power for short-term mortality.
참고문헌 (37)
- Hamm CW, "ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The task force for the management of acute coronary syndrome (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC)", Eur Heart J, 32, pp.2999~3054 (2011)
- Fruergaard P, "The diagnoses of patients admitted with acute chest pain but without myocardial infarction", Eur Heart J, 17, pp.1028~1034 (1996)
- Amsterdam EA, "AHA", ACC Guideline for the management of patients with non-st-elevation acute coronary syndromes: A Report of the American College of Cardiology, J Am Coll Cardiol, pp.2014, 64[DOI]
- O’Gara P, "ACCF", AHA guideline for the management of ST-elevation Myocardial Infarction. A report of the American College of Cardiology Foundation, J Am Coll Cardiol, pp.2013, 61[DOI]
- Keller T, "Sensitive troponin I assay in early diagnosis of acute myocardial infarction", N Engl J Med, 361, pp.868~877 (2009)
- Reiter M, "Early diagnosis of acute myocardial infarction in the elderly using more sensitive cardiac troponin assays", Eur Heart J, 32, pp.1379~1389 (2011)
- Sherwood MW, "High-sensitivity troponin assays: evidence, indications, and reasonable use", J Am Heart Assoc, 3, pp.e000403~ (2014)
- Apple FS, "Analytical characteristics of high-sensitivity cardiac troponin assays", Clin Chem, 58, pp.54~61 (2012)
- Twerenbold R, "High-sensitive troponin T measurements: what do we gain and what are the challenges?", Eur Heart J, 33, pp.579~586 (2012)
- Jaffe AS, "It’s time for a change to a troponin standard", Circulation, 102, pp.1216~1220 (2000)
- White HD, "Pathobiology of troponin elevations: do elevations occur with myocardial ischemia as well as necrosis?", J Am Coll Cardiol, 57, pp.2406~2408 (2011)
- Cullen L, "Validation of high-sensitivity troponin I in a 2-hour diagnostic strategy to assess 30-day outcomes in emergency department patients with possible acute coronary syndrome", J Am Coll Cardiol, 62, pp.1242~1249 (2013)
- de Lemos JA, "Association of troponin T detected with a highly sensitive assay and cardiac structure and mortality risk in the general population", JAMA, 304, pp.2503~2512 (2010)
- Ottani F, "Elevated cardiac troponin levels predict the risk of adverse outcome in patients with acute coronary syndromes", Am Heart J, 140, pp.917~927 (2000)
- Aldous SJ, "Diagnostic and prognostic utility of early measurement with high-sensitivity troponin T assay in patients presenting with chest pain", CMAJ, 184, pp.E260~E268 (2012)
- Kohli P, "Role of ST2 in non-ST-elevation acute coronary syndrome in the MERLIN-TIMI 36 trial", Clin Chem, 58, pp.257~266
- Eggers KM, "ST2 and mortality in non-ST-segment elevation acute coronary syndrome", Am Heart J, 159, pp.788~794 (2010)
- Sabatine MS, "Complementary roles for biomarkers of biomechanical strain ST2 and N-terminal prohormone B-type natriuretic peptide in patients with ST-elevation myocardial infarction", Circulation, 117, pp.1936~1944 (2008)
- Weinberg EO, "Identification of serum soluble ST2 receptor as a novel heart failure biomarker", Circulation, 107, pp.721~726 (2003)
- Turnquist HR, "IL-33 expands suppressive CD11b+ Gr-1(int) and regulatory T cells, including ST2L+ Foxp3+ cells, and mediates regulatory T cell-dependent promotion of cardiac allograft survival", J Immunol, 187, pp.4598~4610 (2011)
- Manzano-Fernández S, "Usefulness of soluble concentrations of interleukin family member ST2 as predictor of mortality in patients with acutely decompensated heart failure relative to left ventricular ejection fraction", Am J Cardiol, 107, pp.259~267 (2011)
- Weir RA, "Serum soluble ST2: a potential novel mediator in left ventricular and infarct remodeling after acute myocardial infarction", J Am Coll Cardiol, 55, pp.243~250 (2010)
- Miller AM, "Soluble ST2 associates with diabetes but not established cardiovascular risk factors: a new inflammatory pathway of relevance to diabetes?", PLoS One, 7, pp.e47830~ (2012)
- Seki K, "Interleukin-33 prevents apoptosis and improves survival after experimental myocardial infarction through ST2 signalling", Circ Heart Fail, 2, pp.684~691 (2009)
- Richards AM, "ST2 in stable and unstable ischemic heart diseases", Am J Cardiol, 115(7S), pp.48B~58B (2015)
- Ky B, "High-sensitivity ST2 for prediction of adverse outcomes in chronic heart failure", Circ Heart Fail, 4, pp.180~187 (2011)
- Erhardt L, "Task force on the management of chest pain", Eur Heart J, 23, pp.1153~1176 (2002)
- Dieplinger B, "Analytical and clinical evaluation of a novel high-sensitivity assay for measurement of soluble ST2 in human plasma - the Presage ST2 assay", Clin Chim Acta, 409, pp.33~40 (2009)
- Apple FS, "Analytical characteristics of high-sensitivity cardiac troponin assays", Clin Chem, 58, pp.54~61 (2012)
- Kavsak PA, "Analytic and clinical utility of a next-generation, highly sensitive cardiac troponin I assay for early detection of myocardial injury", Clin Chem, 55, pp.573~577 (2009)
- Brown AM, "ST2 in emergency department chest pain patients with potential acute coronary syndromes", Ann Emerg Med, 50, pp.153~158 (2007)
- Weinberg EO, "Expression and regulation of ST2, an interleukin-1 receptor family member, in cardiomyocytes and myocardial infarction", Circulation, 106, pp.2961~2966 (2002)
- McCullough PA, "An evidence-based algorithm for the use of B-type natriuretic testing in acute coronary syndromes", Rev Cardiovasc Med, 11(S2), pp.S51~S65 (2010)
- Dhillon OS, "Pre-discharge risk stratification in unselected STEMI: is there a role for ST2 or its natural ligand IL-33 when compared with contemporary risk markers?", Int J Cardiol, 167, pp.2182~2188 (2013)
- Aldous SJ, "ST2 has diagnostic and prognostic utility for all-cause mortality and heart failure in patients presenting to the emergency department with chest pain", J Card Fail, 18, pp.304~310 (2012)
- Demyanets S, "Soluble ST2 and interleukin-33 levels in coronary artery disease: relation to disease activity and adverse outcome", PLoS One, 9, pp.e95055~ (2014)
- Shimpo M, "Serum levels of the interleukin-1 receptor family member ST2 predict mortality and clinical outcome in acute myocardial infarction", Circulation, 109, pp.2186~2190 (2004)