Admission ferritin in STEMI predicts long-term major adverse cardiovascular outcomes.

Q: What are the key findings of this study?

Elevated admission serum ferritin (≥300 ng/mL) in patients with STEMI significantly increased the risk of long-term major adverse cardiovascular events by 43% (HR 1.43) compared to patients with lower ferritin levels.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: ST-segment elevation myocardial infarction (STEMI) (n=475). Intervention: Elevated serum ferritin (≥300 ng/mL) vs. Low serum ferritin (<300 ng/mL). Primary outcome: Major adverse cardiovascular events (MACE), a composite of all-cause death, cardiogenic shock, recurrent MI, and new-onset CHF (HR 1.43, 95% CI 1.06-1.94, p=0.01).

Q: What does this research mean for the field?

Elevated admission serum ferritin (≥300 ng/mL) in patients with STEMI independently predicts an increased risk of long-term major adverse cardiovascular events. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

David A. Brenes-Castro; Jorge Arturo Ortega-Hernandez; Ximena Latapi Ruiz Esparza; J D Sierra-Lara Martinez; José Luis Briseño-de la Cruz; Héctor González-Pacheco; Rodrigo Gopar‐Nieto; Alexandra Arias‐Mendoza; Diego Araiza Garaygordobil

doi:10.1093/ehjopen/oeag092

July 1, 2026Open Access

Admission ferritin in STEMI predicts long-term major adverse cardiovascular outcomes.

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Key result

Elevated admission ferritin linked to ~43% higher long-term MACE risk in STEMI.

HR 1.43
95% CI 1.06-1.94
P=0.01
n=475

Figures

Graphical abstract published by the journal — Graphical abstract · Published by the journal · CC BY

Why the study?

The prognostic role of serum ferritin, an inflammation-sensitive marker of iron metabolism, in STEMI patients remains unclear despite the known relevance of inflammatory biomarkers in ACS.

Does elevated admission serum ferritin (≥300 ng/mL) predict an increased risk of long-term major adverse cardiovascular events in patients with STEMI?

Study Design

Type

Cohort (n=475)

Multicenter

No

Structured PICO

Does elevated admission serum ferritin (≥300 ng/mL) predict an increased risk of long-term major adverse cardiovascular events in patients with STEMI?

P

Population

475 adult patients with STEMI and available admission ferritin data were followed for a mean of 4.5 years to assess the association between elevated ferritin levels and major adverse cardiovascular events.

E

Exposure

Elevated initial serum ferritin level (≥300 ng/mL) assessed within the first 3 days from hospital admission.

C

Comparator

Low initial serum ferritin level (<300 ng/mL).

O

Outcome

Incidence of major adverse cardiovascular events (MACE), defined as a composite of all-cause death, cardiogenic shock, recurrent MI, and new-onset CHF at a mean follow-up of 4.5 years (median 533 days).composite

Main Result

Hazard Ratio: 1.43 (95% CI 1.06–1.94)

Absolute Event Rate: 47.18% vs 35.63%

p-value: p=0.01

Elevated admission serum ferritin (≥300 ng/mL) is a significant and independent predictor of long-term major adverse cardiovascular outcomes, specifically mortality and new-onset heart failure, in STEMI patients.

Limitations

Retrospective, observational design introducing potential selection bias
Approximately 40% of patients were excluded due to missing ferritin values, limiting sample size
Single-centre study in a Latin American cohort, which limits external validity
Exclusion of NSTEMI patients, so findings cannot be extrapolated to that population
Absence of ferroptosis markers, baseline troponin measurements, and serial imaging studies
Use of the earliest available ferritin value without serial measurements
Retrospective, observational design introduces potential selection bias and precludes determination of causality.
~40% of patients were excluded due to missing ferritin values, limiting sample size and subgroup analyses.
Single-centre study in a Latin American cohort limits external validity.
Patients with NSTEMI were not included.
Absence of ferroptosis markers, soluble transferrin receptor levels and/or bone marrow biopsy to further assess iron deficiency.
Lack of baseline troponin measurements and serial imaging studies.
Use of the earliest available ferritin value without serial measurements.

Implication

Elevated ferritin was associated with higher long-term MACE risk after STEMI; leaves open incremental prognostic value and need for prospective validation.

Abstract

Aims: Inflammation is a key driver of atherosclerosis and acute coronary syndromes (ACS). Despite the prognostic relevance of inflammatory biomarkers in STEMI, the role of serum ferritin, an inflammation-sensitive marker of iron metabolism, remains unclear. The purpose of this study is to evaluate the association between elevated ferritin (≥300 ng/mL) and long-term major adverse cardiovascular events (MACE) in patients with STEMI. Methods and results: = 0.02). Conclusion: Elevated ferritin (≥300 ng/mL) is an independent predictor of long-term MACE in STEMI, supporting its potential role as a prognostic biomarker in ACS.

Discussion

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Cite This Study

Brenes-Castro et al. (2026) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=475). Elevated serum ferritin (≥300 ng/mL) vs. Low serum ferritin (<300 ng/mL) was evaluated on Major adverse cardiovascular events (MACE), a composite of all-cause death, cardiogenic shock, recurrent MI, and new-onset CHF (HR 1.43, 95% CI 1.06-1.94, p=0.01). Elevated admission serum ferritin (≥300 ng/mL) in patients with STEMI significantly increased the risk of long-term major adverse cardiovascular events by 43% (HR 1.43) compared to patients with lower ferritin levels.

synapsesocial.com/papers/6ad0fc963afa093ea9acff20 https://doi.org/10.1093/ehjopen/oeag092

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Admission ferritin in STEMI predicts long-term major adverse cardiovascular outcomes.

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Admission ferritin in STEMI predicts long-term major adverse cardiovascular outcomes.

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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