P2682Prognostic value of biomarkers of myocardial fibrosis and renal dysfunction in patients with previous myocardial infarction

Abstract

Background: Modern biomarkers are a promising tool for predicting clinical outcome in cardiovascular patients, which could provide added value to medical management and potentially lower risk of mortality and readmissions. Purpose: To assess the prognostic value of sST2, NGAL, cystatin C and conventional indicators in patients with previous myocardial infarction (MI). Methods: The study enrolled 162 patients with a duration of MI of at least 4 weeks who underwent coronarography. The patients received clinical examination and echocardiography. Enzyme-linked immunosorbent assay was performed to measure blood levels of sST2, NGAL, cystatin C and NT-proBNP. The eGFR was calculated using the CKD-EPI equation. The endpoint was the composite of mortality and rehospitalization due to cardiovascular diseases with 12-month followup. All participants were divided into the major adverse clinical events (MACEs) and MACEs-free groups. Statistical analyses was performed using nonparametric methods. ROC curves were drawn to evaluate the potential roles of indicators in predicting MACEs. Multivariate regression analyses was conducted to identify the independent risk factors. P<0.05 was considered statistically significant. Results: Median age was 57 years, 86,4% were men, 71,6% had heart failure (HF). Most patients underwent emergency coronarography (87,7%) and primary PCI (58,6%). During the follow-up period MACEs occurred in 35 patients. There were no differences in age, frequency of comorbidities, result of revascularization and eGFR between groups (p>0.05 for all). Patients of MACEs-group had more often HF, duration of MI >1 year, LV aneurysm and LVEF<50%, lesion of the trunk of the left coronary artery, more pronounced violation of local LV contractility and coronary injury to the Syntax score (p<0.01 for all). sST2, NGAL, NTproBNP concentrations were higher in MACEs-group (p<0,001 for all); but cys- tatin C levels were comparable. ROC analyses showed similar AUC of biomarkers: sST2-0.796 (95% CI 0.710-0.882, p<0.001), NGAL - 0.800 (95% CI 0.727- 0.873, p<0.001), NT-proBNP - 0.761 (95% CI 0.676-0.847, p<0.001). Biomarkers yielded cut-off values 39.04 ng/mL for sST2 (OR 7.09, 95% CI 2.86-17.56, Se 80%, Sp 63.9%, p<0.001), 17.21 ng/mL for NGAL (OR 12.37, 95% CI 4.10- 37.28, Se 88.6%, Sp 61.5%, p<0.001) and 201.22 pg/mL for NT-proBNP (OR 9.44, 95% CI 3.14-23.38, Se 88.6%, Sp 54.9%, p<0.001). Multivariate analyses identified the independent risk factors for MACEs: NGAL (OR 1.24, 95% CI 1.1- 1.4, p<0.0001), sST2 (OR 1.14, 95% CI 1.06-1.22, p<0.0001), LVEF<50% (OR 3.7, 95% CI 1.12-12.25, p=0.032), duration of MI <1 year (OR 0.07, 95% CI 0.01- 0.42, p=0.003), LV aneurysm (OR 6.08, 95% CI 0.6-61.83, p=0.127). Model led to chi-square 85.1 (p<0.0001) and AUC of 0.929 (95% CI 0.882-0.975, p<0.001). Conclusion: NGAL and sST2 not only provide added value to established risk factors, but also are independent predictors of adverse outcome at 12 months in previous MI patients.