High serum matrix metalloproteinase-9 level predict increased risk of in-hospital cardiac events in patients with type 2 diabetes and ST segment elevation myocardial infarction.
BACKGROUND
The purpose of this study was to compare serum matrix metalloproteinase (MMP)-9 levels in a population of type 2 diabetic versus non-diabetic patients hospitalized with ST-segment elevation myocardial infarction (STEMI) and to examine the relationship between serum MMP-9 levels and the incidence of in-hospital cardiac events, including death and cardiogenic shock.


METHODS
We recruited 120 patients with STEMI, of whom 48 were type 2 diabetic and 72 non-diabetic. Serum MMP-9 levels were measured on admission, using a commercially available ELISA. The primary study endpoint was cardiac death in-hospital and cardiogenic shock.


RESULTS
Mean serum MMP-9 levels were significantly higher in type 2 diabetic patients compared to non-diabetic patients (240+/-52 ng/mL versus 185+/-47 ng/mL; P<0.0001). In multivariable analysis, type 2 diabetes was an independent factor for mortality [OR: 1.75 (1.40-2.30); P=0.005] and cardiogenic shock [OR: 1.55 (1.20-1.70); P=0.03] when the variable MMP-9 level was not introduced into the model, but it was less significantly associated with mortality [OR: 1.60 (1.40-2.10); P=0.01] and no longer associated with cardiogenic shock when MMP-9 was in the model.


CONCLUSIONS
After STEMI, type 2 diabetes is independently associated with high serum MMP-9 levels. This elevated MMP-9 is strongly associated with the increased incidence of in-hospital mortality and cardiogenic shock observed in type 2 diabetes. Our findings clearly indicate that serum MMP-9 provides a highly valuable prognostic information on in-hospital outcome after STEMI, in particular in type 2 diabetic patients.
Dominguez-Rodriguez
Alberto
A
Department of Cardiology (Coronary Care Unit), University Hospital of Canarias, Ofra s/n La Cuesta E-38320, Tenerife, Spain. Electronic address: adrvdg@hotmail.com.
Abreu-Gonzalez
Pedro
P
Department of Physiology, University of La Laguna, School of Medicine, Tenerife, Spain.
Garcia-Gonzalez
Martín J
MJ
Department of Cardiology (Coronary Care Unit), University Hospital of Canarias, Ofra s/n La Cuesta E-38320, Tenerife, Spain.
Kaski
Juan Carlos
JC
Cardiovascular Biology Research Centre, Division of Cardiac and Vascular Sciences, St. George's, University of London, London, United Kingdom.
D000368:Aged; D000788:Angina Pectoris, Variant; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D020780:Matrix Metalloproteinase 9 / Q000097:blood*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012770:Shock, Cardiogenic / Q000150:complications / Q000503:physiopathology
D015415:Biomarkers; D020780:Matrix Metalloproteinase 9