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. 2018 Jun 5;131(11):1282-1288.
doi: 10.4103/0366-6999.232819.

Role of Soluble ST2 Levels and Beta-Blockers Dosage on Cardiovascular Events of Patients with Unselected ST-Segment Elevation Myocardial Infarction

Wei-Ping Huang  1 , Xuan Zheng  1 , Lei He  1 , Xi Su  1 , Cheng-Wei Liu  1 , Ming-Xiang Wu  1
Affiliations

Role of Soluble ST2 Levels and Beta-Blockers Dosage on Cardiovascular Events of Patients with Unselected ST-Segment Elevation Myocardial Infarction

Wei-Ping Huang et al. Chin Med J (Engl). .

Abstract
in English, Chinese

Background: Serum soluble ST2 (sST2) levels are elevated early after acute myocardial infarction and are related to adverse left ventricular (LV) remodeling and cardiovascular outcomes in ST-segment elevation myocardial infarction (STEMI). Beta-blockers (BB) have been shown to improve LV remodeling and survival. However, the relationship between sST2, final therapeutic BB dose, and cardiovascular outcomes in STEMI patients remains unknown.

Methods: A total of 186 STEMI patients were enrolled at the Wuhan Asia Heart Hospital between January 2015 and June 2015. All patients received standard treatment and were followed up for 1 year. Serum sST2 was measured at baseline. Patients were divided into four groups according to their baseline sST2 values (high >56 ng/ml vs. low ≤56 ng/ml) and final therapeutic BB dose (high ≥47.5 mg/d vs. low <47.5 mg/d). Cox regression analyses were performed to determine whether sST2 and BB were independent risk factors for cardiovascular events in STEMI.

Results: Baseline sST2 levels were positively correlated with heart rate (r = 0.327, P = 0.002), Killip class (r = 0.408, P = 0.000), lg N-terminal prohormone B-type natriuretic peptide (r = 0.467, P = 0.000), lg troponin I (r = 0.331, P = 0.000), and lg C-reactive protein (r = 0.307, P = 0.000) and negatively correlated to systolic blood pressure (r = -0.243, P = 0.009) and LV ejection fraction (r = -0.402, P = 0.000). Patients with higher baseline sST2 concentrations who were not titrated to high-dose BB therapy (P < 0.0001) had worse outcomes. Baseline high sST2 (hazard ratio [HR]: 2.653; 95% confidence interval [CI]: 1.201-8.929; P = 0.041) and final low BB dosage (HR: 1.904; 95% CI, 1.084-3.053; P = 0.035) were independent predictors of cardiovascular events in STEMI.

Conclusions: High baseline sST2 levels and final low BB dosage predicted cardiovascular events in STEMI. Hence, sST2 may be a useful biomarker in cardiac pathophysiology.

血清可溶性ST2水平、β受体阻滞剂治疗与ST段抬高型心肌梗死患者预后的关系摘要背景: 有研究发现血清可溶性ST2（sST2）水平在急性心肌梗死发生早期升高，同时与ST段抬高型心肌梗死（STEMI）患者的左心室重构及预后相关。β受体阻滞剂通过改善STEMI患者左心室重构进而改善预后。本研究初步探讨了STEMI患者中基线sST2水平，β受体阻滞剂剂量与预后的关系。 方法: 2015年1月至6月于武汉亚洲心脏病医院纳入符合标准的186名STEMI患者。所有患者接受正规治疗并随访至1年。测量患者基线血清sST2水平。依据基线sST2水平（高sST2>56 ng/ml vs. 低sST2 ≤56 ng/ml）及最终β受体阻滞剂的治疗剂量（高剂量组≥47.5mg vs. 低剂量组 <47.5）分为4组。应用 Cox 回归分析确定sST2水平 、BB剂量在STEMI患者中的预测价值。 结果: 基线sST2水平与心率(r=0.327, p=0.002)、Killip class (r=0.408,p=0.000), lgNTproBNP (r=0.467， p=0.000), lgTnI (r=0.331， p=0.000) 和 lgCRP (r=0.307, p=0.000)正相关，与SBP (r=-0.243，p=0.009) 和 LVEF (r=-0.402, p=0.000)负相关。基线sST2升高伴低剂量BB的患者预后较差（p=0.000）。基线高sST2水平 (HR, 2.653; 95% CI, 1.201-8.929; p=0.041) 及低剂量BB (HR, 1.904; 95% CI, 1.084-3.053; p=0.035) 是STEMI患者出现心血管事件的独立预测因素。 结论: 基线高sST2水平及低剂量BB是STEMI患者出现心血管事件的独立预测因素， sST2 可能是心脏病理生理过程的一个有用生物标记物。.

Keywords: Adrenergic Beta-Antagonists; Prognosis; ST-Elevation Myocardial Infarction; ST2.

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Conflict of interest statement

There are no conflicts of interest

Figures

Figure 1
Figure 1
One-year incidence of cardiovascular events (%) by baseline sST2 values and final BB dosage. BB: Beta-blockers; sST2: Soluble ST2.
Figure 2
Figure 2
Kaplan-Meier analysis by baseline sST2 and final BB dosage. BB: Beta-blocker; sST2: Soluble ST2.
See this image and copyright information in PMC

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