Abstract
BackgroundElevated levels of osteoprotegerin (OPG) have been associated with adverse outcomes in ST-elevation myocardial infarction (STEMI). However, the role of OPG in myocardial injury and adverse remodeling in STEMI patients remains unclear. The aims of this observational cohort study were to evaluate: 1) the temporal profile of OPG during STEMI, 2) possible associations between OPG measured acutely and after 4 months, with infarct size, adverse left ventricular (LV) remodeling, microvascular obstruction (MVO) and myocardial salvage and 3) the effect of heparin administration on OPG levels.MethodsBlood samples were drawn repeatedly from 272 STEMI patients treated with primary percutaneous coronary intervention (PCI). Cardiac magnetic resonance imaging (CMR) was performed in the acute phase and after 4 months. The effect of heparin administration on OPG levels was studied in 20 patients referred to elective coronary angiography.ResultsOPG levels measured acutely were significantly higher than Day 1 and during follow-up. OPG levels were correlated with age. No association was found between early OPG levels and CMR measurements at 4 months. Patients with >median OPG levels measured at Day 1 had larger final infarct size, lower LV ejection fraction (LVEF) at 4 months and higher frequency of MVO. There were no associations between OPG and change in end-diastolic volume or myocardial salvage. OPG remained associated with infarct size and LVEF after adjustment for relevant covariates, except peak troponin T and CRP. A 77% increase in OPG levels following heparin administration was found in patients undergoing elective coronary angiography.ConclusionsOPG was found to be associated with myocardial injury, but not with LV remodeling or myocardial salvage. The use of OPG as a biomarker in STEMI patients seems to be limited by a strong association with age, confounding effect of heparin administration, and little additive value to established biomarkers.
Highlights
Osteoprotegerin (OPG), a glycoprotein in the tumor necrosis factor (TNF) receptor superfamily, acts as a decoy receptor for the receptor activator of nuclear factor-κB ligand (RANKL) and TNF-related apoptosis inducing ligand (TRAIL) [1, 2]
Patients with >median OPG levels measured at Day 1 had larger final infarct size, lower LV ejection fraction (LVEF) at 4 months and higher frequency of MVO
The use of OPG as a biomarker in ST-elevation MI (STEMI) patients seems to be limited by a strong association with age, confounding effect of heparin administration, and little additive value to established biomarkers
Summary
Osteoprotegerin (OPG), a glycoprotein in the tumor necrosis factor (TNF) receptor superfamily, acts as a decoy receptor for the receptor activator of nuclear factor-κB ligand (RANKL) and TNF-related apoptosis inducing ligand (TRAIL) [1, 2]. In a study of 199 STEMI patients, that OPG levels measured a median of 16.5 hours after percutaneous coronary intervention (PCI) were significantly associated with infarct size assessed after 3 months by SPECT imaging [14]. Elevated levels of osteoprotegerin (OPG) have been associated with adverse outcomes in ST-elevation myocardial infarction (STEMI). The role of OPG in myocardial injury and adverse remodeling in STEMI patients remains unclear. The aims of this observational cohort study were to evaluate: 1) the temporal profile of OPG during STEMI, 2) possible associations between OPG measured acutely and after 4 months, with infarct size, adverse left ventricular (LV) remodeling, microvascular obstruction (MVO) and myocardial salvage and 3) the effect of heparin administration on OPG levels
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