Circulating osteoprotegerin levels and long-term prognosis in patients with acute coronary syndromes.
OBJECTIVE
This study was designed to assess the association between osteoprotegerin (OPG) levels on admission and long-term prognosis in patients with acute coronary syndromes (ACS).


BACKGROUND
Osteoprotegerin, a member of the tumor necrosis factor receptor superfamily, has pleiotropic effects on bone metabolism, endocrine function, and the immune system.


METHODS
Serum samples for OPG analysis were obtained within 24 h of admission in 897 ACS patients (median age 66 years, 71% men) and related to the incidence of death, heart failure (HF) hospitalizations, myocardial infarction (MI), and stroke.


RESULTS
A total of 261 patients died during a median follow-up of 89 months. The baseline OPG concentration was strongly associated with increased long-term mortality (hazard ratio [HR] for HR per 1 SD increase in logarithmically transformed OPG level 1.7 [range 1.5 to 1.9] p < 0.0001) and HF hospitalizations (HR 2.0 [range 1.6 to 2.5]; p < 0.0001) but weaker with recurrent MI (HR 1.3 [range 1.0 to 1.5]; p = 0.02) and not with stroke (HR 1.2 [range 0.9 to 1.6]; p = 0.35). After adjustment for conventional risk markers, including troponin I, C-reactive protein (CRP), B-type natriuretic peptide (BNP), and ejection fraction, the association remained significant for mortality (HR 1.4 [range 1.2 to 1.7]; p < 0.0001) and HF hospitalization (HR 1.6 [range 1.2 to 2.1]; p = 0.0002), but not recurrent MI. By comparison of the area under the receiver-operating characteristics curves, OPG performed similarly to BNP and ejection fraction and significantly better than CRP and troponin I as a predictor of death.


CONCLUSIONS
Serum OPG is strongly predictive of long-term mortality and HF development in patients with ACS, independent of conventional risk markers.
Omland
Torbjørn
T
Department of Medicine, Akershus University Hospital, Lørenskog, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway.
Ueland
Thor
T
Jansson
Anna M
AM
Persson
Anita
A
Karlsson
Thomas
T
Smith
Camilla
C
Herlitz
Johan
J
Aukrust
Pål
P
Hartford
Marianne
M
Caidahl
Kenneth
K
D054058:Acute Coronary Syndrome / Q000401:mortality / Q000503:physiopathology*; D000368:Aged; D000789:Angina, Unstable / Q000401:mortality / Q000503:physiopathology*; D015415:Biomarkers; D001842:Bone and Bones / Q000378:metabolism; D004703:Endocrine System; D005260:Female; D006760:Hospitalization; D006801:Humans; D007107:Immune System; D015994:Incidence; D008297:Male; D008875:Middle Aged; D053244:Osteoprotegerin / Q000502:physiology*; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors
D015415:Biomarkers; D053244:Osteoprotegerin