Abstract
Background and aimsCCN family member 1 (CCN1) has recently been proposed as a novel biomarker of myocardial injury, improving prediction of 30-day and one-year mortality following acute coronary syndromes. Among ST-elevation myocardial infarction (STEMI) patients, we evaluated the utility of CCN1 measured immediately before primary percutaneous coronary intervention (PPCI) as a predictor of two earlier endpoints: final myocardial infarct size and post-infarction left ventricular ejection fraction (LVEF). Furthermore, we evaluated the impact of CCN1 on the discriminatory power of the CADILLAC score. MethodsSTEMI patients were obtained from the SPUM-ACS cohort. Serum CCN1 was measured prior to PPCI. Linear regression assessed the association between CCN1, peak creatinine kinase (CK), and post-infarction LVEF. Cox models assessed an association between CCN1 and 30-day all-cause mortality. ResultsCCN1 was measured in 989 patients with a median value of 706.2 ng/l (IQR 434.3–1319.6). A significant correlation between CCN1, myocardial infarct size (peak CK) and LVEF was observed in univariate and multivariate analysis (both p < 0.001). Even among patients with normal classical cardiac biomarker levels at the time of PPCI, CCN1 correlated significantly with final infarct size. CCN1 significantly improved prediction of 30-day all-cause mortality by the CADILLAC score (C-index 0.864, likelihood-ratio chi-square test statistic 6.331, p = 0.012; IDI 0.026, p= 0.050). ConclusionsCompared with classical cardiac biomarkers, CCN1 is potentially the earliest predictor of final myocardial infarct size and post-infarction LVEF. CCN1 improved the discriminatory capacity of the CADILLAC score suggesting a potential role in the very-early risk stratification of STEMI patients.
Highlights
CCN family member 1 (CCN1), known as cysteine-rich angio genic inducer 61 (Cyr61), is a cysteine-rich extracellular matrix protein secreted by endothelial cells, fibroblasts, smooth muscle cells and car diomyocytes [1,2]
Given the early release of CCN1 following myocardial injury, we aimed to evaluate the utility of CCN1 as an early predictor of final myocardial infarct size as compared to other classical biomarkers in patients presenting with ST-elevation myocardial infarction (STEMI)
Among 1029 patients admitted with a STEMI in the SPUM-ACS biomarker cohort, 40 (3.9%) patients were excluded from the analysis due to the absence of a peak creatinine kinase (CK) value
Summary
CCN family member 1 (CCN1), known as cysteine-rich angio genic inducer 61 (Cyr61), is a cysteine-rich extracellular matrix protein secreted by endothelial cells, fibroblasts, smooth muscle cells and car diomyocytes [1,2]. We have recently identified CCN1 as an early biomarker of myocardial injury enabling improved risk stratification among acute coronary syndrome patients [2]. CCN family member 1 (CCN1) has recently been proposed as a novel biomarker of myocardial injury, improving prediction of 30-day and one-year mortality following acute coronary syndromes. Even among patients with normal classical cardiac biomarker levels at the time of PPCI, CCN1 correlated significantly with final infarct size. Conclusions: Compared with classical cardiac biomarkers, CCN1 is potentially the earliest predictor of final myocardial infarct size and post-infarction LVEF. CCN1 improved the discriminatory capacity of the CADILLAC score suggesting a potential role in the very-early risk stratification of STEMI patients
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