Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway.
Heart. 2011 Mar;97(6):460-5. doi: 10.1136/hrt.2010.206714. Epub 2011 Jan 26.
Increased serum osteoprotegerin has been shown to be associated with increased mortality and heart failure development in patients with acute coronary syndromes. The aim of the present study was to elucidate a possible association between serum osteoprotegerin measured acutely in patients with ST-elevation myocardial infarction (STEMI) and final infarct size. METHODS Serum osteoprotegerin was measured in fasting blood samples from 199 patients with acute STEMI, sampled at a median time of 16 h after primary percutaneous coronary intervention (PCI). After 3 months, final infarct size (in percentage of left ventricular mass; LVM) was assessed by single-photon emission CT. The outcome variable final infarct size was dichotomised using the 75th percentile as the cutoff value (large infarct size ≥ 29.0%). A multivariable analysis was performed adjusting for multiple clinical and biochemical covariates.
Median (IQR) osteoprotegerin concentration was 1.4 (1.0, 2.1) ng ml⁻¹ and patients with high osteoprotegerin level (> median) at baseline had larger infarct size at 3 months compared with patients with low osteoprotegerin levels (< median) (25 (8, 40) vs 6 (0, 19)% of LVM, respectively, p < 0.0001). A high osteoprotegerin level was also associated with an approximately sevenfold increase in the odds of developing a large myocardial infarct (OR 7.0; 3.2, 15.5, p < 0.001). After adjustment for potential confounders including peak troponin T, the adjusted OR was 5.2 (2.0, 13.1) p < 0.001.
High levels of circulating osteoprotegerin measured the first morning after a PCI-treated acute STEMI were strongly associated with final infarct size.
已有研究表明，血清护骨素水平升高与急性冠状动脉综合征患者的死亡率和心力衰竭的发生有关。本研究旨在探讨急性 ST 段抬高型心肌梗死（STEMI）患者入院时即刻测量的血清护骨素水平与最终梗死面积之间的可能关系。方法：入选 199 例急性 STEMI 患者，在经皮冠状动脉介入治疗（PCI）后中位数 16 小时采集空腹血样，检测血清护骨素水平。3 个月后，采用单光子发射计算机断层扫描评估最终梗死面积（左心室质量的百分比；LVM）。使用第 75 百分位数作为截断值（大梗死面积≥29.0%）将最终梗死面积的结局变量进行二分法处理。通过多变量分析，调整多种临床和生化混杂因素。结果：中位数（IQR）护骨素浓度为 1.4（1.0，2.1）ng/ml，基线时护骨素水平较高（>中位数）的患者与护骨素水平较低（<中位数）的患者相比，3 个月时的梗死面积更大（分别为 25（8，40）%和 6（0，19）%的 LVM，p<0.0001）。护骨素水平较高还与发生大面积心肌梗死的几率增加约 7 倍相关（OR 7.0；3.2，15.5，p<0.001）。调整包括肌钙蛋白 T 峰值在内的潜在混杂因素后，调整后的 OR 为 5.2（2.0，13.1），p<0.001。结论：PCI 治疗后急性 STEMI 患者入院时第 1 天清晨测得的循环护骨素水平与最终梗死面积密切相关。
