The Correlation Between Soluble ST2 And Myocardial Fibrosis And Major Cardiac Adverse Events After Acute Myocardial Infarction

Objective: To explore the relationship between soluble ST2(sST2)and myocardial fibrosis after acute myocardial infarction(AMI),and clearing whether soluble ST2 has predictable value for major adverse cardiovascular events(MACE)of AMI after percutaneous coronary intervention(PCI).Methods: The study selected 249 patients from January 1,2015 to January 31,2016 at the heart center of first hospital in Lanzhou University.There are 166 patients in the AMI group who were diagnosed as acute myocardial infarction for the first time,and the control group has 83 patients with negative coronary angiography.Collecting the relevant indicators of patient’s clinical baseline data,blood routine,blood biochemistry and echocardiography,and detecting the value of serum soluble ST2,type III procollagen aminotransferase(PIIINP)and amino-terminal brain natriuretic peptide(NT-proBNP),then following up patients from the AMI group for 1 year after PCI by telephone.According to the follow-up results,the AMI group was divided into MACE events group(include 23 patienes)and non-MACE events group(include 143 patients).Finally,analyzing the data using statistical methods.Results: 1.The value of circulation soluble ST2,PIIINP,NT-proBNP,and the norm correlation with cardiac doppler in group AMI are higher than those in control group,while the value of left ventricular ejection fraction(LVEF)are lower than control group,two groups have statistical differences(P<0.05).2.In group AMI,serum soluble ST2 is affected by the body mass index,blood pressure,triglycerides,aspartate aminotransferase,left ventricular end-systolic volume(LVESV)and left ventricular ejection fraction(LVEF),serum soluble ST2 and MACE,PIIINP have positive correlation,while have no relation with NT-ProBNP.3.The serum soluble ST2,NT-proBNP in the AMI group can diagnose herat faliure after AMI,and areas under ROC curve of them are respectively 0.608,0.683.4.The circulation soluble ST2 concentration of the MACE group are higher than the non-MACE group significantly [(44.50 ±5.32)ng/mLvs(23.59±1.15)ng/mL,P=0.001];logistic multivariate analysis of statistical analysis showed that serum soluble ST2(OR: 1.051,95%CI:1.016~1.087)is the predictive factor of MACE in AMI patients after PCI.5.In AMI patients after PCI,the area under the ROC curve of soluble ST2 was 0.787 to predict the occurrence of MACE,higher than NT-proBNP,and when soluble ST2 combined with NT-proBNP,the area under the curve was improve to 0.82.6.According to the ROC curve obtained the maximum tangent point of soluble ST2(30ng / mL),the survival curve shows that the mortality rate of one year after PCI in serum-soluble ST2 level ≤ 30 ng / mL group are lower than soluble ST2 level > 30 ng / mL group(0.81% vs 7.1%,P=0.04),and has statistical significance.Conclusions: 1.Serum soluble ST2 participates in the process of myocardial fibrosis after AMI,and have a relationship with left ventricular systolic function,also have diagnostic value for heart faliure after AMI.2.Serum soluble ST2 can be used as an independent predictor of MACE events after PCI,and combined with NT-proBNP can improve the predictive value of MACE events after PCI.3.The higher the level of soluble ST2,the lower the 1-year survival rate after PCI.