Pedersen Sune, Mogelvang Rasmus, Bjerre Mette, Frystyk Jan, Flyvbjerg Allan, Galatius Soren, Sørensen Tor Biering, Iversen Allan, Hvelplund Anders, Jensen Jan S
Department of Cardiology P, Copenhagen University Hospital, Copenhagen, Denmark.
Cardiology. 2012;123(1):31-8. doi: 10.1159/000339880. Epub 2012 Sep 7.
Osteoprotegerin (OPG) is a glycoprotein with a regulatory role in immune, skeletal and vascular systems. Data suggest that high circulating OPG levels are associated with an increased risk of cardiovascular disease. We analyzed the association between OPG and long-term outcome in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI).
We included 716 consecutive STEMI patients admitted to a single high-volume invasive heart center from September 2006 to December 2008. Endpoints were all-cause mortality, repeat myocardial infarction, admission due to heart failure and combinations thereof. Median follow-up lasted 27 months (interquartile range: 22-33).
OPG levels exhibited a non-Gaussian distribution and were therefore divided into quartiles. High levels of OPG were significantly associated with a worse outcome. After adjustment for conventional risk factors (e.g. C-reactive protein, estimated glomerular filtration rate, symptom-to-balloon time and troponin I) using Cox regression, OPG remained a significantly independent predictor of death (HR per increase in OPG quartile: 1.28; CI: 1.03-1.59; p = 0.03), repeat myocardial infarction (HR: 1.30; CI: 1.00-1.68; p = 0.05) and admission with heart failure (HR: 1.50; CI: 1.18-1.90; p = 0.001).
This study shows that OPG independently predicts long-term outcome in STEMI patients treated with pPCI. Eventually, this knowledge could improve risk stratification and overall outcome.
骨保护素（OPG）是一种在免疫、骨骼和血管系统中起调节作用的糖蛋白。数据表明，循环中骨保护素水平升高与心血管疾病风险增加有关。我们分析了骨保护素与接受直接经皮冠状动脉介入治疗（pPCI）的ST段抬高型心肌梗死（STEMI）患者的长期预后之间的关联。
我们纳入了2006年9月至2008年12月期间连续入住一家大型侵入性心脏中心的716例STEMI患者。终点指标为全因死亡率、再次心肌梗死、因心力衰竭入院以及这些情况的组合。中位随访时间为27个月（四分位间距：22 - 33个月）。
骨保护素水平呈非高斯分布，因此被分为四分位数。骨保护素水平高与较差的预后显著相关。使用Cox回归对传统风险因素（如C反应蛋白、估计肾小球滤过率、症状发作至球囊扩张时间和肌钙蛋白I）进行调整后，骨保护素仍然是死亡（骨保护素四分位数每增加一级的风险比：1.28；可信区间：1.03 - 1.59；p = 0.03）、再次心肌梗死（风险比：1.30；可信区间：1.00 - 1.68；p = 0.05）和因心力衰竭入院（风险比：1.50；可信区间：1.18 - 1.90；p = 0.001）的显著独立预测因子。
本研究表明，骨保护素独立预测接受pPCI治疗的STEMI患者的长期预后。最终，这一认识可能会改善风险分层和总体预后。
