High osteoprotegerin levels predict MACCE in STEMI patients, but are not associated with myocardial salvage.
OBJECTIVE
High circulating levels of osteoprotegerin (OPG) carry prognostic impact in cohorts with various cardiovascular diagnoses. With the present study, we aim to investigate the role of OPG within the scale of myocardial damage.


METHODS
This study includes 219 consecutive patients with acute ST-elevation myocardial infarction randomized to primary percutaneous coronary intervention (pPCI) or pPCI and remote ischemic per-conditioning. Salvage index via myocardial single-photon emission CT assessment (data available in 61% of the patients) was performed, and derived from Day 1 (myocardial area at risk) and Day 30 (final infarct size). Plasma OPG levels were measured using an in-house immunoassay. A combined end-point of all-mortality, myocardial infarction, stroke, readmission for heart failure and ischemic stroke/transient ischemic attack (Major Adverse Cardiac and Cerebrovascular Events [MACCE]) was used for follow-up; 45 (38-48 months).


RESULTS
High OPG levels were associated with the severity of cardiovascular disease. During follow-up, OPG was a predictor of MACCE (unadjusted, HR: 2.1, 95% CI: 1.14-3.85, P = 0.017). Adjustments for age, gender, and body mass index preserved the independent predictive power of OPG. However, OPG levels were neither associated with salvage index nor with the final infarct size. Remote ischemic per-conditioning had no effect on OPG levels.


CONCLUSIONS
Despite absent association between OPG levels and the scale of myocardial damage, high OPG levels predict a significantly increased risk of MACCE.
The Medical Research Laboratory, Department of Clinical Medicine, Faculty of Health, Aarhus University , Aarhus C , Denmark.
Mette
M
Bjerre
Kim
K
Munk
Astrid Drivsholm
AD
Sloth
Søren Steen
SS
Nielsen
Allan
A
Flyvbjerg
Hans Erik
HE
Bøtker
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000209:etiology / Q000401:mortality; D003718:Denmark; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality; D006801:Humans; D007118:Immunoassay; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000401:mortality; D019194:Ischemic Preconditioning / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D053244:Osteoprotegerin / Q000097:blood*; D010359:Patient Readmission; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D015854:Up-Regulation; D034941:Upper Extremity / Q000098:blood supply*
D015415:Biomarkers; D053244:Osteoprotegerin; C506030:TNFRSF11B protein, human
OPG; STEMI; myocardial salvage index