Prognostic value of serum tenascin-C levels on long-term outcome after acute myocardial infarction.
BACKGROUND
Tenascin-C (TN-C), an extracellular matrix glycoprotein, is not normally expressed in the adult heart but transiently reappears under various pathologic conditions to play important roles in tissue remodeling. It is unclear whether serum TN-C levels add prognostic information independent from traditional prognostic markers.


RESULTS
We assessed 239 patients with first ST-segment elevation myocardial infarction who underwent successful percutaneous coronary intervention. We measured serum TN-C and plasma B-type natriuretic peptide (BNP) levels on day 5 after admission and compared long-term clinical outcome. During the follow-up period (24.3 ± 13 months), 54 patients experienced primary composite cardiac events (cardiac death or hospitalization for worsening heart failure). Multivariable Cox proportional hazards analysis indicated that serum TN-C (hazard ratio 2.92, 95% confidence interval [CI] 1.55-5.67; P < .001) and plasma BNP levels (hazard ratio 1.84, 95% CI 1.17-2.97; P = .008) were significant independent predictors for cardiac events after adjustment for multiple confounders. The combination of TN-C and BNP resulted in an increase of the c-statistic from 0.821 to 0.877 (P < .001) and an integrated discrimination improvement gain of 14.0% (P < .001).


CONCLUSIONS
Serum TN-C level on day 5 after admission is potentially useful for early risk stratification after AMI beyond established prognostic markers.
Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. asato@md.tsukuba.ac.jp
Akira
A
Sato
Michiaki
M
Hiroe
Daiki
D
Akiyama
Hiroyuki
H
Hikita
Toshihiro
T
Nozato
Tomoya
T
Hoshi
Taizo
T
Kimura
Zheng
Z
Wang
Satoshi
S
Sakai
Kyoko
K
Imanaka-Yoshida
Toshimichi
T
Yoshida
Kazutaka
K
Aonuma
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D003643:Death; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality / Q000628:therapy; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D019063:Tenascin / Q000097:blood*
D015415:Biomarkers; D019063:Tenascin; D020097:Natriuretic Peptide, Brain