Department of Cardiology P, Gentofte University Hospital, Copenhagen, Denmark.
Department of Cardiology P, Gentofte University Hospital, Copenhagen, Denmark; Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
Can J Cardiol. 2014 Dec;30(12):1523-8. doi: 10.1016/j.cjca.2014.08.015. Epub 2014 Aug 23.
High levels of circulating osteoprotegerin (OPG) predicts long-term outcome in patients with ST-elevation myocardial infarction (STEMI), possibly because of increased vascular inflammation resulting in myocardial damage. In the present study we aimed at elucidating the dynamic progress of OPG levels during STEMI treated with percutaneous coronary intervention (PCI) and additionally, the effect of OPG levels on cardiac function.
We prospectively included 42 patients with STEMI treated with primary PCI. Four consecutive blood samples were obtained before and after PCI treatment. Plasma OPG levels were determined using an in-house immunoassay. Cardiac function was increased according to echocardiography, estimating left ventricular ejection fraction (LVEF) 1-3 days after STEMI.
During STEMI, OPG levels peaked after PCI and then decreased; mean concentrations (95% confidence interval) before PCI, after PCI, and on day 1 and day 2 of 2650 ng/L (2315-3036 ng/L), 2778 ng/L (2442-3363 ng/L), 2024 ng/L (1775-230 6 ng/L), and 1808 ng/L (1551-2106 ng/L), respectively (P < 0.001). Interestingly, the OPG response was observed before the response in troponin I and C-reactive protein. Patients with reduced LVEF (< 40%) exhibited an increased OPG response before, during, and after PCI (mean increase, 38%; 9%-75%; repeated measures analysis of variance, P = 0.009). Adjustment for age, sex, body mass index, and cardiovascular risk factors did not significantly affect the association between reduced LVEF and increased OPG response (mean increase 33% (4%-70%; F = 5.784; P = 0.023).
Circulating OPG levels are altered during STEMI treated with primary PCI. A high OPG level is independently associated with impaired LVEF.
高水平的循环骨保护素（OPG）可预测 ST 段抬高型心肌梗死（STEMI）患者的长期预后，这可能是由于血管炎症增加导致心肌损伤。在本研究中，我们旨在阐明经皮冠状动脉介入治疗（PCI）治疗后 STEMI 期间 OPG 水平的动态变化，并探讨 OPG 水平对心功能的影响。
我们前瞻性纳入了 42 例接受直接 PCI 治疗的 STEMI 患者。在 PCI 治疗前后采集 4 个连续的血样。使用内部免疫测定法测定血浆 OPG 水平。根据超声心动图评估左心室射血分数（LVEF），在 STEMI 后 1-3 天评估心功能。
在 STEMI 期间，OPG 水平在 PCI 后达到峰值，然后下降；PCI 前、PCI 后、第 1 天和第 2 天的平均浓度（95%置信区间）分别为 2650ng/L（2315-3036ng/L）、2778ng/L（2442-3363ng/L）、2024ng/L（1775-2306ng/L）和 1808ng/L（1551-2106ng/L）（P<0.001）。有趣的是，OPG 反应先于肌钙蛋白 I 和 C 反应蛋白的反应。LVEF 降低（<40%）的患者在 PCI 前后均表现出 OPG 反应增加（平均增加 38%；9%-75%；重复测量方差分析，P=0.009）。调整年龄、性别、体重指数和心血管危险因素后，LVEF 降低与 OPG 反应增加之间的关联并未显著改变（平均增加 33%（4%-70%；F=5.784；P=0.023）。
在接受直接 PCI 治疗的 STEMI 患者中，循环 OPG 水平发生改变。高水平的 OPG 与 LVEF 受损独立相关。
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