High osteopontin levels predict long-term outcome after STEMI and primary percutaneous coronary intervention.

BACKGROUND: Osteopontin (OPN), a multifunctional glycoprotein, has recently been found to be an important player in cardiovascular diseases and to be implicated in a variety of acute as well as chronic inflammatory processes, including atherosclerosis. This study investigates the association between plasma OPN at admission and the long-term outcome in patients with ST segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI).

METHODS: We included a total of 730 consecutive STEMI patients admitted to a single high-volume invasive heart centre between September 2006 and December 2008. Plasma OPN and high sensitivity C-reactive protein (hsCRP) were measured.

RESULTS: The median follow-up time was 27 months (interquartile range: 22-33) and endpoints were all-cause mortality, re-infarction and heart failure. Even when adjusted for all baseline variables, increasing OPN was independently associated with increased all-cause mortality, and the combined endpoint, a linear increase in OPN of 10 µg/l, was associated with a hazard ratio (HR) of 1.05 (95% confidence interval (CI): 1.02-1.08; p = 0.002) for all-cause mortality and HR 1.03 (95%CI: 1.01-1.05; p = 0.047) for the combined endpoint. Importantly, OPN interacted with the predictive power of hsCRP, and the combination of high OPN levels and high hsCRP levels (>3 mg/l) were significantly associated with increased risk of all-cause mortality (HR: 2.32; CI: 1.51-3.58; p < 0.001), re-infarction (HR: 2.19; CI: 1.22-3.93; p = 0.006), heart failure (HR: 1.84; CI: 1.08-3.13; p = 0.025) and the combined endpoint (HR: 2.08; CI: 1.53-2.84; p < 0.001).

CONCLUSIONS: In conclusion, a high OPN level, especially in combination with a high hsCRP level, was associated with poor long-term outcome in STEMI patients treated with pPCI.