title: Plasma osteoprotegerin level on admission is associated with no-reflow phenomenon after primary angioplasty and subsequent left ventricular remodeling in patients with acute ST-segment elevation myocardial infarction.
abstract: OBJECTIVE
  Osteoprotegerin (OPG) upregulates endothelial cell adhesion molecule response to TNF-α by upregulating angiopoietin-2 (Ang-2). The aim of this study was to investigate the association between admission plasma levels of OPG, Ang-2 and TNF-α in patients with acute ST-segment elevation myocardial infarction (STEMI) and no-reflow after primary angioplasty and subsequent left ventricular remodeling (LVR).
  
  
  METHODS
  Ninety-two patients with first STEMIs, reperfused within 12 h of symptom onset, were included. LVR was defined as a >20% increase in LV end-diastolic volume at 6-month follow-up assessed using echocardiography.
  
  
  RESULTS
  The incidences of angiographic no-reflow and electrocardiographic no-reflow were 40.2% and 55.4%, respectively. Thirty-six percent of patients subsequently developed LVR. OPG levels were significantly higher in patients who developed angiographic no-reflow (173 pg/ml, interquartile range [IQR] 83-416 vs 104 pg/ml, IQR 57-235; p=0.04), electrocardiographic no-reflow (160 pg/ml, IQR 81-315 vs 102 pg/ml, IQR 47-230; p=0.025) and LVR (174 pg/ml, IQR 120-342 vs 97 pg/ml, IQR 51-219; p=0.004). In multivariable logistic regression, OPG level was an independent predictor of angiographic (OR 1.05: 95% CI 1.01-1.08 [per 10 pg/ml increase]; p=0.005) and electrocardiographic (OR 1.04: 95% CI 1.00-1.07 [per 10 pg/ml increase]; p=0.04) no-reflow. ROC analysis showed an area under the curve of 0.69 for OPG and LVR. Plasma OPG≥132 pg/ml showed a sensitivity of 72% and a specificity of 61% for predicting LVR (OR 4.05: 95% CI 1.06-15.38; p=0.04).
  
  
  CONCLUSIONS
  High OPG level on admission is significantly associated with no-reflow after primary angioplasty and subsequent LVR at follow-up in patients with STEMI.
authors.affiliation: Kocaeli Derince Education and Research Hospital, Department of Cardiology, Kocaeli, Turkey. ayhanerkol@yahoo.com
authors.forename: Ayhan
authors.initials: A
authors.lastname: Erkol
authors.forename: Vecih
authors.initials: V
authors.lastname: Oduncu
authors.forename: Selçuk
authors.initials: S
authors.lastname: Pala
authors.forename: Filiz
authors.initials: F
authors.lastname: Kızılırmak
authors.forename: Alev
authors.initials: A
authors.lastname: Kılıcgedik
authors.forename: Fatih
authors.initials: F
authors.lastname: Yılmaz
authors.forename: Ahmet
authors.initials: A
authors.lastname: Güler
authors.forename: Can Yücel
authors.initials: CY
authors.lastname: Karabay
authors.forename: Cevat
authors.initials: C
authors.lastname: Kırma
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D042702:Angiopoietin-2 / Q000097:blood; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D054318:No-Reflow Phenomenon / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D016017:Odds Ratio; D053244:Osteoprotegerin / Q000097:blood*; D010343:Patient Admission; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D014421:Turkey; D015854:Up-Regulation; D020257:Ventricular Remodeling
chemical_list: D042702:Angiopoietin-2; D015415:Biomarkers; D053244:Osteoprotegerin; C506030:TNFRSF11B protein, human; D014409:Tumor Necrosis Factor-alpha