Medical School of Chinese PLA, Beijing, China; Department of Cardiovascular Internal Medicine, Second Medical Center, Chinese PLA General Hospital, Beijing, China.
Department of Cardiovascular Internal Medicine, Second Medical Center, Chinese PLA General Hospital, Beijing, China.
Ann Palliat Med. 2020 Jul;9(4):1976-1989. doi: 10.21037/apm-20-1046.
Elevated serum soluble ST2 (sST2) level is marker of poor prognosis in chronic heart failure (HF). N-terminal pro-brain natriuretic peptide (NT-proBNP) is an important biomarker in cardiovascular diseases. This study aimed to address the incremental usefulness of the combined use of high-sensitivity sST2 and NT-proBNP for predicting the risk of major adverse cardiovascular events (MACEs) in patients with coronary heart disease (CHD).
We used patient data along with data established by our research group to compare the performance of a combination of biomarkers reflecting ventricular fibrosis, remodeling, stretch and deterioration of cardiac function (sST2 and NT-proBNP) with that of established mortality risk factors [age, diabetes, systolic blood pressure, diastolic blood pressure, left ventricular ejection fraction (LVEF), body mass index (BMI), creatinine (Cr), uric acid (UA), glucose (Glu)] in stratifying the risk of MACEs in CHD patients.
The median follow-up period was 3.9 years, during which time there were 3,724 cases with CHD, 113 cases of cardiovascular death, 30 cases with myocardial infarction, 49 cases with stroke, 39 cases of non-cardiovascular death, 6 cases of peripheral arterial occlusion, 55 cases with HF, and 73 cases of revascularization. A total of 365 cases had MACEs. In the multivariate Cox proportional hazard model, both sST2 and NT-proBNP were significant predictors of MACEs. Both sST2 and NT-proBNP were separately incorporated into the model with established MACE risk factors, which significantly improved the C-statistics for predicting MACEs [0.758 (0.724-0.792)] and saw an estimated net improvement in reclassification of 1.03% (P<0.001) and an integrated discrimination improvement of 0.48% (P<0.001). The Hosmer-Lemeshow test showed that the models were well calibrated with and without the two biomarkers (P>0.344 for all comparisons). Moreover, the model incorporating the two biomarkers was shown to have a better global fit than the model with only the established MACE risk factors (P<0.001).
A model incorporating sST2 and NT-proBNP was shown to outperform a model based on established MACE risk factors alone in stratifying risk of MACEs in a group of CHD patients.
血清可溶性 ST2（sST2）水平升高是慢性心力衰竭（HF）预后不良的标志物。氨基末端脑利钠肽前体（NT-proBNP）是心血管疾病的重要生物标志物。本研究旨在探讨高敏 sST2 和 NT-proBNP 联合使用对预测冠心病（CHD）患者主要不良心血管事件（MACEs）风险的额外有用性。
我们使用患者数据和我们研究小组建立的数据，比较反映心室纤维化、重塑、伸展和心功能恶化的生物标志物（sST2 和 NT-proBNP）的组合与已确立的死亡率风险因素[年龄、糖尿病、收缩压、舒张压、左心室射血分数（LVEF）、体重指数（BMI）、肌酐（Cr）、尿酸（UA）、葡萄糖（Glu）]在分层 CHD 患者发生 MACE 风险方面的表现。
中位随访时间为 3.9 年，期间共有 3724 例 CHD 患者，心血管死亡 113 例，心肌梗死 30 例，中风 49 例，非心血管死亡 39 例，外周动脉闭塞 6 例，心力衰竭 55 例，血管再通 73 例。共有 365 例发生 MACE。多变量 Cox 比例风险模型中，sST2 和 NT-proBNP 均为 MACE 的显著预测因子。sST2 和 NT-proBNP 分别被纳入具有既定 MACE 风险因素的模型中，这显著提高了预测 MACE 的 C 统计量[0.758（0.724-0.792）]，并估计重新分类的净改善为 1.03%（P<0.001），综合判别改善为 0.48%（P<0.001）。Hosmer-Lemeshow 检验表明，有或没有这两种生物标志物的模型校准良好（所有比较的 P>0.344）。此外，与仅包含既定 MACE 风险因素的模型相比，包含这两种生物标志物的模型显示出更好的整体拟合度（P<0.001）。
在一组 CHD 患者中，包含 sST2 和 NT-proBNP 的模型在分层 MACE 风险方面优于仅基于既定 MACE 风险因素的模型。
