Dataset Information

Syndecan-1 Predicts Outcome in Patients with ST-Segment Elevation Infarction Independent from Infarct-related Myocardial Injury.

ABSTRACT: Syndecan-1 (sdc1) is a surface protein part of the endothelial glycocalyx (eGC). Soluble sdc1 is derived from shedding and indicates damaged eGC. We assessed the predictive value of plasma sdc1 concentrations for future cardiovascular events in acute reperfused ST-segment elevation myocardial infarction (STEMI) patients. A total of 206 patients admitted for STEMI were included in this study (29% female; age 65?±?12 years) and followed-up for six months. Plasma samples were obtained post-intervention and analyzed for sdc1 by Enzyme-linked Immunosorbent Assay (ELISA). Primary outcome was six-month-mortality. Sdc1 did not correlate with biomarkers such as creatine kinase (CK) (r?=?0.11; p?=?0.01) or troponin (r?=?-0.12; p?=?0.09), nor with infarct size (r?=?-0.04; p?=?0.67) and myocardial salvage index (r?=?0.11; p?=?0.17). Sdc-1 was associated with mortality (changes per 100?ng/mL sdc-1 concentration; HR 1.08 95% 1.03-1.12; p?=?0.001). An optimal cut-off was calculated at >120?ng/mL. After correction for known risk factors sdc1 >120?ng/mL was independently associated with mortality after 6 months. In our study, sdc1 is independently associated with six-month-mortality after STEMI. Combining clinical evaluation and different biomarkers assessing both infarct-related myocardial injury and systemic stress response might improve the accuracy of predicting clinical prognosis in STEMI patients.

SUBMITTER: Wernly B

PROVIDER: S-EPMC6892872 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Syndecan-1 Predicts Outcome in Patients with ST-Segment Elevation Infarction Independent from Infarct-related Myocardial Injury.

Wernly Bernhard B Fuernau Georg G Masyuk Maryna M Muessig Johanna Maria JM Pfeiler Susanne S Bruno Raphael Romano RR Desch Steffen S Muench Phillip P Lichtenauer Michael M Kelm Malte M Adams Volker V Thiele Holger H Eitel Ingo I Jung Christian C

Scientific reports 20191204 1

Syndecan-1 (sdc1) is a surface protein part of the endothelial glycocalyx (eGC). Soluble sdc1 is derived from shedding and indicates damaged eGC. We assessed the predictive value of plasma sdc1 concentrations for future cardiovascular events in acute reperfused ST-segment elevation myocardial infarction (STEMI) patients. A total of 206 patients admitted for STEMI were included in this study (29% female; age 65 ± 12 years) and followed-up for six months. Plasma samples were obtained post-interven ...[more]

PMID: 31797997

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Project description:ImportanceChallenges to improving ST-segment elevation myocardial infarction (STEMI) care are formidable in low- to middle-income countries because of several system-level factors.ObjectiveTo examine access to reperfusion and percutaneous coronary intervention (PCI) during STEMI using a hub-and-spoke model.Design, setting, and participantsThis multicenter, prospective, observational study of a quality improvement program studied 2420 patients 20 years or older with symptoms or signs consistent with STEMI at primary care clinics, small hospitals, and PCI hospitals in the southern state of Tamil Nadu in India. Data were collected from the 4 clusters before implementation of the program (preimplementation data). We required a minimum of 12 weeks for the preimplementation data with the period extending from August 7, 2012, through January 5, 2013. The program was then implemented in a sequential manner across the 4 clusters, and data were collected in the same manner (postimplementation data) from June 12, 2013, through June 24, 2014, for a mean 32-week period.ExposuresCreation of an integrated, regional quality improvement program that linked the 35 spoke health care centers to the 4 large PCI hub hospitals and leveraged recent developments in public health insurance schemes, emergency medical services, and health information technology.Main outcomes and measuresPrimary outcomes focused on the proportion of patients undergoing reperfusion, timely reperfusion, and postfibrinolysis angiography and PCI. Secondary outcomes were in-hospital and 1-year mortality.ResultsA total of 2420 patients with STEMI (2034 men [84.0%] and 386 women [16.0%]; mean [SD] age, 54.7 [12.2] years) (898 in the preimplementation phase and 1522 in the postimplementation phase) were enrolled, with 1053 patients (43.5%) from the spoke health care centers. Missing data were common for systolic blood pressure (213 [8.8%]), heart rate (223 [9.2%]), and anterior MI location (279 [11.5%]). Overall reperfusion use and times to reperfusion were similar (795 [88.5%] vs 1372 [90.1%]; P = .21). Coronary angiography (314 [35.0%] vs 925 [60.8%]; P < .001) and PCI (265 [29.5%] vs 707 [46.5%]; P < .001) were more commonly performed during the postimplementation phase. In-hospital mortality was not different (52 [5.8%] vs 85 [5.6%]; P = .83), but 1-year mortality was lower in the postimplementation phase (134 [17.6%] vs 179 [14.2%]; P = .04), and this difference remained consistent after multivariable adjustment (adjusted odds ratio, 0.76; 95% CI, 0.58-0.98; P = .04).Conclusions and relevanceA hub-and-spoke model in South India improved STEMI care through greater use of PCI and may improve 1-year mortality. This model may serve as an example for developing STEMI systems of care in other low- to middle-income countries.

Project description:BACKGROUND:Myocardial recovery after primary percutaneous coronary intervention in acute myocardial infarction is variable and the extent and severity of injury are difficult to predict. We sought to investigate the role of cardiovascular magnetic resonance T1 mapping in the determination of myocardial injury very early after treatment of ST-segment elevation myocardial infarction (STEMI). METHODS:STEMI patients underwent 3?T cardiovascular magnetic resonance (CMR), within 3?h of primary percutaneous intervention (PPCI). T1 mapping determined the extent (area-at-risk as %left ventricle, AAR) and severity (average T1 values of AAR) of acute myocardial injury, and related these to late gadolinium enhancement (LGE), and microvascular obstruction (MVO). The characteristics of myocardial injury within 3?h was compared with changes at 24-h to predict final infarct size. RESULTS:Forty patients were included in this study. Patients with average T1 values of AAR ?1400?ms within 3?h of PPCI had larger LGE at 24-h (33% ±14 vs. 18% ±10, P?=?0.003) and at 6-months (27% ±9 vs. 12% ±9; P?<?0.001), higher incidence and larger extent of MVO (85% vs. 40%, P?=?0.016) & [4.0 (0.5-9.5)% vs. 0 (0-3.0)%, P?=?0.025]. The average T1 value was an independent predictor of acute LGE (? 0.61, 95%CI 0.13 to 1.09; P?=?0.015), extent of MVO (? 0.22, 95%CI 0.03 to 0.41, P?=?0.028) and final infarct size (? 0.63, 95%CI 0.21 to 1.05; P?=?0.005). Receiver-operating-characteristic analysis showed that T1 value of AAR obtained within 3-h, but not at 24-h, predicted large infarct size (LGE >?9.5%) with 100% positive predictive value at the optimal cut-off of 1400?ms (area-under-the-curve, AUC 0.88, P?=?0.006). CONCLUSION:Hyper-acute T1 values of the AAR (within 3?h post PPCI, but not 24?h) predict a larger extent of MVO and infarct size at both 24?h and 6?months follow-up. Delayed CMR scanning for 24?h could not substitute the significant value of hyper-acute average T1 in determining infarct characteristics.

Dataset Information

Syndecan-1 Predicts Outcome in Patients with ST-Segment Elevation Infarction Independent from Infarct-related Myocardial Injury.

Publications

Syndecan-1 Predicts Outcome in Patients with ST-Segment Elevation Infarction Independent from Infarct-related Myocardial Injury.

Similar Datasets

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