title: Combined Measurement of Soluble ST2 and Amino-Terminal Pro-B-Type Natriuretic Peptide Provides Early Assessment of Severity in Cardiogenic Shock Complicating Acute Coronary Syndrome.
abstract: OBJECTIVE
  Mortality in cardiogenic shock complicating acute coronary syndrome is high, and objective risk stratification is needed for rational use of advanced therapies such as mechanical circulatory support. Traditionally, clinical variables have been used to judge risk in cardiogenic shock. The aim of this study was to assess the added value of serial measurement of soluble ST2 and amino-terminal pro-B-type natriuretic peptide to clinical parameters for risk stratification in cardiogenic shock.
  
  
  METHODS
  CardShock (www.clinicaltrials.gov NCT01374867) is a prospective European multinational study of cardiogenic shock. The main study introduced CardShock risk score, which is calculated from seven clinical variables at baseline, and was associated with short-term mortality.
  
  
  METHODS
  Nine tertiary care university hospitals.
  
  
  METHODS
  Patients with cardiogenic shock caused by acute coronary syndrome (n=145).
  
  
  METHODS
  In this substudy, plasma samples from the study patients were analyzed at eight time points during the ICU or cardiac care unit stay. Additional prognostic value of the biomarkers was assessed with incremental discrimination improvement.
  
  
  RESULTS
  The combination of soluble ST2 and amino-terminal pro-B-type natriuretic peptide showed excellent discrimination for 30-day mortality (area under the curve, 0.77 at 12 hr up to 0.93 at 5-10 d after cardiogenic shock onset). At 12 hours, patients with both biomarkers elevated (soluble ST2, ≥ 500 ng/mL and amino-terminal pro-B-type natriuretic peptide, ≥ 4,500 ng/L) had higher 30-day mortality (79%) compared to those with one or neither biomarkers elevated (31% or 10%, respectively; p < 0.001). Combined measurement of soluble ST2 and amino-terminal pro-B-type natriuretic peptide at 12 hours added value to CardShock risk score, correctly reclassifying 11% of patients.
  
  
  CONCLUSIONS
  The combination of results for soluble ST2 and amino-terminal pro-B-type natriuretic peptide provides early risk assessment beyond clinical variables in patients with acute coronary syndrome-related cardiogenic shock and may help therapeutic decision making in these patients.
authors.affiliation: 1INSERM UMR-S942, Paris, France.2Heart Center, Päijät-Häme Central Hospital, Lahti, Finland.3Division of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Hospital, Helsinki, Finland.4Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain.5Department of Anesthesia and Critical Care, University Hospital Saint Louis Lariboisière, APHP, Paris, France.6Department of Clinical Chemistry, University of Eastern Finland and Eastern Finland Laboratory Centre, Kuopio, Finland.7Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.8Division of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.9Clinical research platform (URCEST-CREST), University Hospitals Paris Est, APHP, Saint Antoine Hospital, Paris, France.10Heart Failure Clinic and Secondary Cardiology Department, Attikon University Hospital, Athens, Greece.11Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.12International Clinical Research Centre, ICRC, Brno, Czech Republic.13Division of Cardiology, Massachusetts General Hospital, Boston, MA.14Department of Emergency Care, Helsinki University and Helsinki University Hospital, Helsinki, Finland.15University Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Heli
authors.initials: H
authors.lastname: Tolppanen
authors.forename: Mercedes
authors.initials: M
authors.lastname: Rivas-Lasarte
authors.forename: Johan
authors.initials: J
authors.lastname: Lassus
authors.forename: Malha
authors.initials: M
authors.lastname: Sadoune
authors.forename: Etienne
authors.initials: E
authors.lastname: Gayat
authors.forename: Kari
authors.initials: K
authors.lastname: Pulkki
authors.forename: Mattia
authors.initials: M
authors.lastname: Arrigo
authors.forename: Evguenia
authors.initials: E
authors.lastname: Krastinova
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sionis
authors.forename: John
authors.initials: J
authors.lastname: Parissis
authors.forename: Jindrich
authors.initials: J
authors.lastname: Spinar
authors.forename: James
authors.initials: J
authors.lastname: Januzzi
authors.forename: Veli-Pekka
authors.initials: VP
authors.lastname: Harjola
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications*; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D000072179:Interleukin-1 Receptor-Like 1 Protein / Q000097:blood*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012770:Shock, Cardiogenic / Q000097:blood* / Q000209:etiology* / Q000401:mortality
chemical_list: D015415:Biomarkers; C079241:IL1RL1 protein, human; D000072179:Interleukin-1 Receptor-Like 1 Protein; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain