Key result
Elevated soluble ST2 levels were independently associated with an increased risk of major adverse cardiovascular events (HR 1.010) in patients with CMR-confirmed myocardial infarction with non-obstructive coronary arteries.
Why the study?
Does elevated sST2 predict major adverse cardiovascular events in patients with CMR-confirmed MINOCA?
Cohort (n=97)
No
Does elevated sST2 predict major adverse cardiovascular events in patients with CMR-confirmed MINOCA?
Elevated sST2 levels are independently associated with an increased risk of major adverse cardiovascular events in patients with CMR-confirmed MINOCA, suggesting its utility as a practical biomarker for risk stratification.
Background Cardiac magnetic resonance (CMR) plays an essential role in identifying the underlying etiology of myocardial infarction with non-obstructive coronary arteries (MINOCA). However, risk stratification in patients with CMR-confirmed MINOCA remains insufficiently defined. Soluble suppression of tumorigenicity 2 (sST2), a biomarker related to myocardial fibrosis and adverse cardiac remodeling, may provide additional prognostic information in this population. This study aimed to evaluate the prognostic value of sST2 in patients with CMR-confirmed MINOCA. Methods This single-center retrospective study included patients suspected of MI who underwent coronary angiography and completed CMR during hospitalization. MACE included all-cause death, recurrent MI, stroke, heart failure, arrhythmia, and angina pectoris. MINOCA was defined by evidence of ischemia or infarction on CMR. sST2 was tested using an immunoassay kit according to the protocol during hospitalization. Results A total of 97 patients with CMR-confirmed MINOCA were included. During a median follow-up of 24.2 months, 33 patients experienced MACE. Patients with MACE had significantly higher sST2 levels and worse CMR parameters, including lower left ventricular ejection fraction, greater late gadolinium enhancement extent, larger left ventricular end-systolic volume index, and impaired global longitudinal strain (GLS). Multivariable Cox regression analysis showed that sST2 (HR 1.010, 95% CI 1.003–1.017, P = 0.005) and GLS (HR 0.864, 95% CI 0.780–0.956, P = 0.005) were independently associated with MACE. Receiver operating characteristic analysis demonstrated moderate predictive performance for sST2, with an area under the curve of 0.696. Kaplan–Meier analysis showed that patients with sST2 ≥ 36.95 ng/mL had a significantly higher risk of MACE. Conclusions Elevated sST2 is independently associated with adverse outcomes in patients with CMR-confirmed MINOCA. sST2 may serve as a practical biomarker for risk stratification in this population.
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Cui et al. (2026) conducted a cohort in Myocardial infarction with non-obstructive coronary arteries (MINOCA) (n=97). Soluble ST2 (sST2) vs. Lower sST2 levels was evaluated on Major adverse cardiovascular events (MACE) (HR 1.010, 95% CI 1.003-1.017, p=0.005). Elevated soluble ST2 levels were independently associated with an increased risk of major adverse cardiovascular events (HR 1.010) in patients with CMR-confirmed myocardial infarction with non-obstructive coronary arteries.
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