Key result
Admission plasma levels of soluble thrombomodulin and syndecan-1 were not independently associated with 30-day mortality (sTM HR 1.06; 95% CI 0.996-1.12; P=0.07) or late cardiogenic shock in STEMI.
Why the study?
Are admission plasma levels of sTM and syndecan-1 associated with the development of cardiogenic shock and 30-day mortality in patients with suspected STEMI?
Cohort (n=1,467)
Are admission plasma levels of sTM and syndecan-1 associated with the development of cardiogenic shock and 30-day mortality in patients with suspected STEMI?
While admission levels of sTM and syndecan-1 are elevated in STEMI patients with early cardiogenic shock, they are not independently associated with late shock development or 30-day mortality.
Answers are grounded in this paper and cite their sources.
These markers should not inform STEMI risk stratification; hypothesis-generating for endothelial injury in cardiogenic shock.
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-1 compared with no CS patients. Patients developing late CS had higher sTM plasma concentration compared with patients without shock. However, the biomarker levels were not independently associated with late CS and mortality.
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Frydland et al. (2018) conducted a cohort in Suspected ST-elevation myocardial infarction (STEMI) (n=1,467). Elevated plasma levels of soluble thrombomodulin (sTM) and syndecan-1 vs. Lower biomarker levels was evaluated on 30-day mortality (for sTM) (HR 1.06, 95% CI 0.996-1.12, p=0.07). Admission plasma levels of soluble thrombomodulin and syndecan-1 were not independently associated with 30-day mortality (sTM HR 1.06; 95% CI 0.996-1.12; P=0.07) or late cardiogenic shock in STEMI.
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