The Predictive Value of the Combination of Soluble ST2 and N Terminal-Pro Brain Natriuretic Peptide for Short-Term Mortality in ST-Elevation Myocardial Infarction Patients with Poor PostProcedural TIMI Flow
Keywords: Brain natriuretic peptide, no-reflow phenomenon, mortality, percutaneous coronary intervention
Introduction: The increase in soluble ST2 (sST2) and N Terminal-Pro Brain Natriuretic Peptide (NT-proBNP) in ST-elevation myocardial infarction (STEMI) is well established, however, the existing data regarding the combination of sST2 and NT-proBNP values as prognostic markers after STEMI are limited, particularly in the case of those with failed percutaneous coronary intervention (PCI). This study aimed to assess the clinical significance of the sST2 and NT-proBNP combination in predicting short-term mortality in STEMI patients with post-procedural poor thrombolysis in myocardial infarction (TIMI) flow. Patients and Methods: A total of 104 patients with post-procedural poor TIMI flow were included in the study. Failure to provide a 3 flow grade was accepted as post-procedural poor TIMI flow. The study population was grouped according to the sST2 and NT-proBNP levels. Independent predictors of short-term mortality were investigated. Results: A 30 day mortality was observed in 15 (14.4%) patients. sST2 (46.9 ± 23.8 ng/mL vs. 32.5 ± 12.0 ng/ mL, p= 0.001) and NT-proBNP (2387.2 ± 2255.5 pg/mL vs. 1217.1 ± 1588.8 pg/mL, p= 0.015) levels were higher in patients with mortality. Multivariate regression analysis concluded that high serum sST2 (OR: 5.024, 95% CI 1.132-22.308, p= 0.034) independently predicted short-term mortality, while NT-proBNP did not (OR: 4.059, 95% CI 0.894-18.427, p= 0.070). Furthermore, when a high sST2 level was combined with a high NT-proBNP level, the odds ratio of the 30-day mortality was found to be the highest (13.02, 95% CI 5.41-31.23, p< 0.001). Conclusion: These results suggest that the combined sST2 and NT-proBNP level are essential predictors of short-term mortality in STEMI patients with post-procedural poor TIMI flow.