title: Osteoprotegerin levels in ST-elevation myocardial infarction: Temporal profile and association with myocardial injury and left ventricular function.
abstract: BACKGROUND
  Elevated levels of osteoprotegerin (OPG) have been associated with adverse outcomes in ST-elevation myocardial infarction (STEMI). However, the role of OPG in myocardial injury and adverse remodeling in STEMI patients remains unclear. The aims of this observational cohort study were to evaluate: 1) the temporal profile of OPG during STEMI, 2) possible associations between OPG measured acutely and after 4 months, with infarct size, adverse left ventricular (LV) remodeling, microvascular obstruction (MVO) and myocardial salvage and 3) the effect of heparin administration on OPG levels.
  
  
  METHODS
  Blood samples were drawn repeatedly from 272 STEMI patients treated with primary percutaneous coronary intervention (PCI). Cardiac magnetic resonance imaging (CMR) was performed in the acute phase and after 4 months. The effect of heparin administration on OPG levels was studied in 20 patients referred to elective coronary angiography.
  
  
  RESULTS
  OPG levels measured acutely were significantly higher than Day 1 and during follow-up. OPG levels were correlated with age. No association was found between early OPG levels and CMR measurements at 4 months. Patients with >median OPG levels measured at Day 1 had larger final infarct size, lower LV ejection fraction (LVEF) at 4 months and higher frequency of MVO. There were no associations between OPG and change in end-diastolic volume or myocardial salvage. OPG remained associated with infarct size and LVEF after adjustment for relevant covariates, except peak troponin T and CRP. A 77% increase in OPG levels following heparin administration was found in patients undergoing elective coronary angiography.
  
  
  CONCLUSIONS
  OPG was found to be associated with myocardial injury, but not with LV remodeling or myocardial salvage. The use of OPG as a biomarker in STEMI patients seems to be limited by a strong association with age, confounding effect of heparin administration, and little additive value to established biomarkers.
authors.affiliation: Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway.|Center for Clinical Heart Research, Oslo University Hospital Ullevål, Oslo, Norway.|Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Christian
authors.initials: C
authors.lastname: Shetelig
authors.affiliation: Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway.|Center for Clinical Heart Research, Oslo University Hospital Ullevål, Oslo, Norway.|Feiring Heart Clinic, Feiring, Norway.
authors.forename: Shanmuganathan
authors.initials: S
authors.lastname: Limalanathan
authors.affiliation: Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway.|Center for Clinical Heart Research, Oslo University Hospital Ullevål, Oslo, Norway.|Center for Heart Failure Research, Oslo, Norway.
authors.forename: Jan
authors.initials: J
authors.lastname: Eritsland
authors.affiliation: Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway.|Section of Interventional Cardiology, Oslo University Hospital Ullevål, Oslo, Norway.
authors.forename: Pavel
authors.initials: P
authors.lastname: Hoffmann
authors.affiliation: Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway.|Center for Clinical Heart Research, Oslo University Hospital Ullevål, Oslo, Norway.|Faculty of Medicine, University of Oslo, Oslo, Norway.|Center for Heart Failure Research, Oslo, Norway.
authors.forename: Ingebjørg
authors.initials: I
authors.lastname: Seljeflot
authors.affiliation: Oslo Center for Biostatistics and Epidemiology, Department of Biostatistics, Oslo University Hospital and University of Oslo, Oslo, Norway.
authors.forename: Jon Michael
authors.initials: JM
authors.lastname: Gran
authors.affiliation: Faculty of Medicine, University of Oslo, Oslo, Norway.|Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.|Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Oslo, Norway.|K.G. Jebsen Inflammatory Research Center, University of Oslo, Oslo, Norway.
authors.forename: Pål
authors.initials: P
authors.lastname: Aukrust
authors.affiliation: Faculty of Medicine, University of Oslo, Oslo, Norway.|Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.|K.G. Jebsen Inflammatory Research Center, University of Oslo, Oslo, Norway.
authors.forename: Thor
authors.initials: T
authors.lastname: Ueland
authors.affiliation: Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway.|Center for Clinical Heart Research, Oslo University Hospital Ullevål, Oslo, Norway.|Center for Heart Failure Research, Oslo, Norway.
authors.forename: Geir Øystein
authors.initials: GØ
authors.lastname: Andersen
mesh_terms: D006801:Humans; D008279:Magnetic Resonance Imaging; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000503:physiopathology; D053244:Osteoprotegerin / Q000378:metabolism*; D016277:Ventricular Function, Left
chemical_list: D053244:Osteoprotegerin