Prognostic Value of Soluble ST2 After Myocardial Infarction: A Community Perspective.
Soluble ST2 (sST2) is a marker of cardiac mechanical strain hypothesized to adversely impact short-term prognosis after myocardial infarction. We examined the association of sST2 with longer-term outcomes after myocardial infarction in a geographically defined community.



Olmsted County, Minnesota residents who experienced an incident (first-ever) myocardial infarction between November 1, 2002 and December 31, 2012 were prospectively enrolled; sST2 levels were measured. Patients were followed for heart failure and death.



We studied 1401 patients with incident myocardial infarction (mean age 67 years; 61% men; 79% non-ST-elevation myocardial infarction). Median sST2 (ng/mL) was 48.7 (25th-75thpercentile 32.5-103.3). Soluble ST2 was elevated in 51% of patients. Higher values of sST2 were associated with increased age, female sex, and comorbidities. During 5 years of follow-up, 388 persons died and 360 developed heart failure. After adjustment for age, sex, comorbidities, Killip class, and troponin T, the hazard ratios for death were 1.73 (95% confidence interval [CI], 1.22-2.45) and 3.57 (95% CI, 2.57-4.96) for sST2 tertiles 2 and 3, respectively (Ptrend<.001). For heart failure, the hazard ratios were 1.67 (95% CI, 1.18-2.37) and 2.88 (95% CI, 2.05-4.05), respectively (Ptrend<.001). Results were similar among 30-day survivors.



In the community, sST2 elevation is present in half of myocardial infarctions. Higher values of sST2 are associated with a large excess risk of death and heart failure independently of other prognostic indicators. Measurement of sST2 should be considered for risk stratification after myocardial infarction.
Division of Cardiovascular Diseases in the Department of Internal Medicine, Mayo Clinic, Rochester, Minn.
William S
WS
Jenkins
Division of Cardiovascular Diseases in the Department of Internal Medicine, Mayo Clinic, Rochester, Minn; Department of Health Sciences Research, Mayo Clinic, Rochester, Minn. Electronic address: roger.veronique@mayo.edu.
Véronique L
VL
Roger
Division of Cardiovascular Diseases in the Department of Internal Medicine, Mayo Clinic, Rochester, Minn.
Allan S
AS
Jaffe
Department of Health Sciences Research, Mayo Clinic, Rochester, Minn.
Susan A
SA
Weston
Division of Cardiovascular Diseases in the Department of Internal Medicine, Mayo Clinic, Rochester, Minn.
Omar F
OF
AbouEzzeddine
Department of Health Sciences Research, Mayo Clinic, Rochester, Minn.
Ruoxiang
R
Jiang
Department of Health Sciences Research, Mayo Clinic, Rochester, Minn.
Sheila M
SM
Manemann
Division of Cardiovascular Diseases in the Department of Internal Medicine, Mayo Clinic, Rochester, Minn.
Maurice
M
Enriquez-Sarano
D017677:Age Distribution; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D006801:Humans; D000072179:Interleukin-1 Receptor-Like 1 Protein / Q000097:blood*; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D017678:Sex Distribution; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; C079241:IL1RL1 protein, human; D000072179:Interleukin-1 Receptor-Like 1 Protein; D020107:Troponin T
Heart failure; Mortality; Myocardial infarction; Soluble ST2