Plasma Concentration of Biomarkers Reflecting Endothelial Cell- and Glycocalyx Damage are Increased in Patients With Suspected ST-Elevation Myocardial Infarction Complicated by Cardiogenic Shock

TY - JOUR

T1 - Plasma Concentration of Biomarkers Reflecting Endothelial Cell- and Glycocalyx Damage are Increased in Patients With Suspected ST-Elevation Myocardial Infarction Complicated by Cardiogenic Shock

AU - Frydland, Martin

AU - Ostrowski, Sisse Rye

AU - Møller, Jacob Eifer

AU - Hadziselimovic, Edina

AU - Holmvang, Lene

AU - Ravn, Hanne Berg

AU - Jensen, Lisette Okkels

AU - Pettersson, Anna Sina

AU - Kjaergaard, Jesper

AU - Lindholm, Matias Greve

AU - Johansson, Pär Ingemar

AU - Hassager, Christian

PY - 2018

Y1 - 2018

N2 - Background: Mortality in ST-elevation myocardial infarction (STEMI) patients developing cardiogenic shock (CS) during hospitalization is high. Catecholamines, ischemia, and inflammation (parameters present in CS) affect the endothelium. We hypothesized that plasma level of biomarkers reflecting endothelial damage would be associated with CS and mortality. Methods: In 96% of 1467 consecutive patients with suspected STEMI, biomarkers reflecting endothelial cell- (soluble thrombomodulin, sTM) and glycocalyx- (syndecan-1) damage were measured on admission. Patients were stratified by CS development or not. CS-Patients were substratified by CS on admission (admission-CS), CS developed in the catheterization laboratory (cath. lab.-CS), or late CS. Results: STEMI patients with admission-CS (n=85) and cath.lab.-CS (n=25) had higher levels of sTM and syndecan-1 compared with no-CS patients (n=1,299). Late CS-patients (n=58) had higher levels of sTM (median (25th; 75th percentile) 8.8 (7.0; 11.6) vs. 7.4 (6.0; 9.0) ng/mL, P=0.0004) but not Syndecan-1 (P=0.26) compared with no-CS patients. sTM was, however, not independently associated with late CS development (OR (95% CI) 1.07 (0.99-1.16), P=0.09). Patients with the highest level of sTM and syndecan-1 had the highest 30-day mortality (Plogrank<0.0001). However, neither sTM nor Syndecan-1 was independently associated with 30-day mortality (HR (95% CI) sTM: 1.06 (0.996-1.12), P=0.07; Syndecan-1: 1.04 (0.99-1.08), P=0.12). Conclusion: Patients with suspected STEMI patients and admission-CS/cath.lab.-CS had elevated admission levels of sTM and Syndecan-1comparedwith noCSpatients.Patients developing lateCShad higher sTMplasma concentrationcompared with patients without shock. However, the biomarker levels were not independently associated with late CS and mortality.

AB - Background: Mortality in ST-elevation myocardial infarction (STEMI) patients developing cardiogenic shock (CS) during hospitalization is high. Catecholamines, ischemia, and inflammation (parameters present in CS) affect the endothelium. We hypothesized that plasma level of biomarkers reflecting endothelial damage would be associated with CS and mortality. Methods: In 96% of 1467 consecutive patients with suspected STEMI, biomarkers reflecting endothelial cell- (soluble thrombomodulin, sTM) and glycocalyx- (syndecan-1) damage were measured on admission. Patients were stratified by CS development or not. CS-Patients were substratified by CS on admission (admission-CS), CS developed in the catheterization laboratory (cath. lab.-CS), or late CS. Results: STEMI patients with admission-CS (n=85) and cath.lab.-CS (n=25) had higher levels of sTM and syndecan-1 compared with no-CS patients (n=1,299). Late CS-patients (n=58) had higher levels of sTM (median (25th; 75th percentile) 8.8 (7.0; 11.6) vs. 7.4 (6.0; 9.0) ng/mL, P=0.0004) but not Syndecan-1 (P=0.26) compared with no-CS patients. sTM was, however, not independently associated with late CS development (OR (95% CI) 1.07 (0.99-1.16), P=0.09). Patients with the highest level of sTM and syndecan-1 had the highest 30-day mortality (Plogrank<0.0001). However, neither sTM nor Syndecan-1 was independently associated with 30-day mortality (HR (95% CI) sTM: 1.06 (0.996-1.12), P=0.07; Syndecan-1: 1.04 (0.99-1.08), P=0.12). Conclusion: Patients with suspected STEMI patients and admission-CS/cath.lab.-CS had elevated admission levels of sTM and Syndecan-1comparedwith noCSpatients.Patients developing lateCShad higher sTMplasma concentrationcompared with patients without shock. However, the biomarker levels were not independently associated with late CS and mortality.

U2 - 10.1097/SHK.0000000000001123

DO - 10.1097/SHK.0000000000001123

M3 - Journal article

C2 - 29438221

SN - 1073-2322

VL - 50

SP - 538

EP - 544

JO - Shock

JF - Shock

IS - 5

ER -