Clinical InvestigationAcute Ischemic Heart DiseaseInterleukin 33 and ST2 in non–ST-elevation myocardial infarction: Comparison with Global Registry of Acute Coronary Events Risk Scoring and NT-proBNP
Section snippets
Study Population
We studied 577 consecutive patients with NSTEMI admitted to University Hospitals of Leicester National Health Service Trust between February 1, 2005, and May 1, 2007. The study complied with the Declaration of Helsinki and was approved by the local ethics committee; written informed consent was obtained from all patients. Non–ST-elevation myocardial infarction was diagnosed according to the established criteria9 when cardiac troponin I (Advia Centaur Troponin-I assay; Siemens, Deerfield, IL)
Patient characteristics
We recruited 577 patients whose characteristics are recorded in Table I. Mean follow-up was 532 days (range 150-1059 days) during which 156 patients (27%) reached the primary end point (MACE) of which 75 (13%) died, 52 (9%) were readmitted with HF, and 62 (11%) had a reinfarction. No patient was lost to follow-up.
ST2 levels and clinical variables
Median ST2 in the whole cohort was 638 pg/mL (range 82-18875). ST2 was elevated in patients who experienced the primary end point (median 782 pg/mL, P < .001) (Figure 1) and the
Discussion
In 2005, IL-33 was found to be the natural ligand for membrane-bound ST2L2; and this is the first study assessing the relationship between both IL-33 and soluble ST2 levels and adverse events in real-world patients with NSTEMI. The findings of this study are 4-fold. Firstly, we have demonstrated that elevated ST2 is associated with a poor prognosis during the longer term in NSTEMI. Secondly, on evaluating the end points separately, we showed that the relationship with adverse outcome is
Limitations
Our findings were based on a single-center population with 2 admitting hospitals. Plasma samples were obtained at a single time 3 to 5 days postevent by which point 304 patients (52.7%) had IL-33 levels below the lower detection limit of the assay (5.40 pg/mL), affecting the ratio of IL-33 to ST2 and any calculations using that variable. More sensitive IL-33 assays or earlier sampling may have yielded different results. We have shown that measuring ST2 3 to 5 days postevent continues to offer
Conclusion
In consecutive patients with NSTEMI, ST2 is predictive of death and reinfarction but does not yield sufficient incremental benefit for GRACE scoring or NT-proBNP to warrant clinical use for risk stratification. We have evaluated IL-33, for the first time, and report that a significant proportion of patients with NSTEMI mount a low IL-33 response and neither IL-33 nor its ratio with ST2 was related to adverse outcome.
Acknowledgements
Prof Ng, Prof Squire, and Dr. J. Davies are supported by the Leicester National Institute for Health Research Cardiovascular Biomedical Research Unit, UK.
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Dr Dhillon was supported by a British Heart Foundation Junior Research Fellowship (grant no. FS/03/028/15486).