Increased soluble ST2 predicts long-term mortality in patients with stable coronary artery disease

Abstract

Background: Soluble ST2 (sST2) has emerged as a strong prognostic biomarker in patients with heart failure and myocardial infarction. There is no published data on sST2 in patients with stable coronary artery disease (CAD). Therefore, the aim of this study was to evaluate the long-term prognostic value of sST2 in patients with stable CAD. Methods: sST2 plasma concentrations were measured in 1345 patients with stable CAD referred to coronary angiography at a single tertiary care center. The primary enpoint was all-cause mortality. Results: During a median follow-up time of 9.8 years, 477 (36%) patients died. The median sST2 plasma concentration at baseline was significantly higher among decedents than survivors (21.4 vs. 18.5 U/mL; p<0.001). In univariate Cox proportional-hazard regression analysis sST2 (per 1SD increase in log transformed values) displayed a risk ratio (RR) of 1.5 (95% CI 1.4-1.6; p<0.001) for all-cause mortality. After adjustment for clinical variables (including age, diabetes, and left ventricular ejection fraction) and several other biomarkers (including hs-cTnT and NT-proBNP), sST2 remained an independent predictor of mortality (RR 1.1, 95% CI 1.0-1.3; p=0.004). When stratifying the entire cohort according to cut-offs between the third and the fourth quartiles for sST2, hs-cTnT and NT-proBNP, Kaplan-Meier curve analysis revealed that patients with all three biomarkers below these cut-offs displayed survival probability of 80%. In contrast, patients with elevation of all three biomarkers displayed a survival probability of only 14% (Figure 1). ![Figure][1] All-cause mortality in stable CAD Conclusions: In this cohort of patients with stable CAD, increased sST2 was an independent predictor of long-term all-cause mortality and provided complementary prognostic information to hs-cTnT and NT-proBNP. [1]: pending:yes