Could sST2 Predict Contrast-Induced Nephropathy in ST-Segment Elevation Myocardial Infarction?

Figures & data

Table 1 Basic Clinical Characteristics of CIN (+) Group and CIN (−) Group

Variables	CIN (+) (n=81)	CIN (−) (n=276)	P value
Demographics
Age, years	60.5±12.2	59.1±11.7	0.355
Male, n (%)	63 (77.8)	245 (82.2)	0.364
BMI, kg/m^2	26.8±2.7	26.2±3.2	0.117
SBP, mmHg	112.0±24.5	132.0±22.8	<0.001
DBP, mmHg	64.6±12.8	74.9±12.7	<0.001
Heart rate, bpm	76.8±14.1	80.2±15.2	0.079
Medical history, n (%)
Diabetes	30 (37.0)	67 (24.3)	0.023
Hypertension	35 (43.2)	87 (31.5)	0.051
Hyperlipidemia	10 (12.3)	39 (14.1)	0.681
Smoking	33 (40.7)	135 (48.9)	0.195
Pre-procedure medications, n (%)
ACE inh/ARB	23 (28.4)	67 (24.3)	0.453
Antiplatelet	12 (14.8)	21 (7.6)	0.054
Beta blocker	17 (21.0)	43 (15.6)	0.252
Statin	12 (14.8)	44 (15.9)	0.806
Laboratory measurements
Serum creatinine mg/dl	1.08±0.87	0.94±0.46	0.06
Peak serum creatinine mg/dl	1.64±1.34	0.94±0.37	<0.001
eGFR, mL/min/1.73m^2	84.7±28.9	93.3±22.2	0.005
HDL-C, mmol/L	39.3±7.6	41.1±15.3	0.306
LDL-C, mmol/L	120.8±39.5	124.4±39.1	0.460
WBC, 10^9/L	12.1±5.0	12.8±9.2	0.500
Hemoglobin, mg/dl	13.0±2.3	14.0±5.7	0.099
Peak troponin, mg/dl	5.0±3.3	4.7±10.7	0.825
CK-MB, mg/dl	150.8±107.4	125.2±114.8	0.074
sST-2, ng/mL	40.6±21.0	31.5.±13.0	<0.001
Procedural characteristics
Contrast volume, mL	225.7±79.6	208.9±69.2	0.065
Total procedure time, min	32.8±17.4	25.4±13.5	<0.001
Number of stents	1.35±0.59	1.29±0.51	0.332
Culprit artery, n (%)			0.372
LAD	31 (38.3)	115 (41.6)
Cx	15 (18.5)	48 (17.5)
RCA	27 (33.3)	98 (35.5)
Multivessel	8 (9.9)	15 (5.4)

Abbreviations: ACE inh, angiotensin-converting enzyme inhibitors; ARB, angiotensin II receptor blocker; BMI, body mass index; bpm, beat per minute; CK-MB, creatine kinase-myocardial band; Cx, circumflex coronary artery; CIN, contrast-induced nephropathy; DBP, diastolic blood pressure; eGFR, estimated glomerular filtration rate; HDL-C, high-density lipoprotein cholesterol; LAD, left anterior descending coronary artery; LDL-C, low-density lipoprotein cholesterol; PCI, percutaneous coronary intervention; RCA, right coronary artery; SBP, systolic blood pressure; sST2, soluble ST2; WBC, white blood cell.

Figure 1 Numbers and percentages of CIN (+) and CIN (−) groups according to baseline sST2 cut-off value of >35 ng/mL.

Table 2 Multivariate Logistic Regression Analysis for Potential Predictors of Contrast-Induced Nephropathy

	Univariate Analysis OR (CI 95%)	P value	Multivariate Analysis OR (CI 95%)	P value
First model^¶
Age, years	0.998 (0.970–1.027)	0.876
DM, yes	1.916 (1.134–3.237)	0.015	2.028 (1.102–3.732)	0.023
HT, yes	0.981 (0.498–1.934)	0.956
Peak troponin, mg/dl	0.988 (0.957–1.021)	0.474
eGFR<60 mL/min/1.73m^2	4.312 (1.984–9.371)	<0.001	4.488 (2.126–9.474)	<0.001
Anemia, yes	1.461 (0.739–2.891)	0.276
SBP, mmHg*	0.975 (0.958–0.992)	0.004	0.966 (0.953–0.978)	<0.001
DBP, mmHg*	0.967 (0.937–0.998)	0.038
sST-2	1.102 (1.045–1.162)	<0.001	1.101 (1.046–1.160)	<0.001
Contrast volume, dl	1.367 (0.954–1.910)	0.117
Total procedure time, min	1.030 (1.010–1.050)	0.003	1.032 (1.014–1.050)	0.001
Second model^†
Low sST2	Ref.	Ref.	Ref.	Ref.
High sST2	3.059 (1.826–5.124)	<0.001	3.319 (1.830–6.019)	<0.001
Third model^¥
Low sST2	Ref.	Ref.	Ref.	Ref.
High sST2	3.252 (1.864–5.673)	<0.001	2.802 (1.511–5.193)	<0.001

Notes: *SBP and DBP were highly correlated, and Nagelkerke R squares for nighttime SBP and DBP were 17.7% and 16.5%, respectively; therefore, we included SBP in the full model. ^¶Independent predictors of CIN were investigated in regression analysis. sST2 was put into regression analysis as continuous variable. ^†These groups were included in a second model instead of s-ST2 as continuous variable. In this model, Patients were divided into 2 groups according to the sST2 value determined in the ROC curve and the effect of high ST2 value on contrast nephropathy formation was evaluated. ^¥In the third modeling, The definition of CIN was determined according to the criteria published in the Journal of the American College of Cardiology and the power of sSt2 to predict CIN was investigated. ^¶Nagelkerke R square of the first model was 31.5%. † Nagelkerke R square of the second model was 34.4%. ^¥Nagelkerke R square of the third model was 29.4%.

Abbreviations: DM, diabetes mellitus; HT, hypertension; min, minute; eGFR, estimated glomerular filtration rate; SBP, systolic blood pressure; DBP, diastolic blood pressure; sST2, soluble ST2; dl, deciliter; OR, odds ratio; CI, confidence interval.

Figure 2 Receiver operating characteristics curve showing the distinguishing ability of soluble ST2 level for contrast-induced nephropathy.

Abbreviations: AUC, area under the ROC curve; CI, confidence interval; ROC, receiver operating characteristics.