Ann Lab Med 2017; 37(2): 137-146  https://doi.org/10.3343/alm.2017.37.2.137
Comparison Between Soluble ST2 and High-Sensitivity Troponin I in Predicting Short-Term Mortality for Patients Presenting to the Emergency Department With Chest Pain
Rossella Marino, M.D.1, Laura Magrini, M.D.1, Francesca Orsini, M.D.1, Veronica Russo, M.D.1, Patrizia Cardelli, Ph.D.2, Gerardo Salerno, M.T.2, Mina Hur, M.D.3, and Salvatore Di Somma, M.D.1, on behalf of the GREAT NETWORK
Department of Medical-Surgery Sciences and Translational Medicine1, University Sapienza Rome, Sant’ Andrea Hospital, Rome, Italy; Clinical and Molecular Medicine Department2, Sant’ Andrea Hospital, School of Medicine and Psychology, “Sapienza” University, Rome, Italy; Department of Laboratory Medicine3, School of Medicine, Konkuk University, Seoul, Korea
Correspondence to: Salvatore Di Somma
Department of Medical-Surgery Sciences and Translational Medicine, University Sapienza Rome, Sant’ Andrea Hospital, Grottarossa Street 1035/1039, Rome 00189, Italy
Tel: +0633775592 E-mail: salvatore.disomma@uniroma1.it
Received: July 19, 2016; Revised: September 21, 2016; Accepted: December 5, 2016; Published online: March 1, 2017.
© The Korean Society for Laboratory Medicine. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: High-sensitivity cardiac troponin I (hs-cTnI) and the soluble isoform of suppression of tumorigenicity 2 (sST2) are useful prognostic biomarkers in acute coronary syndrome (ACS). The aim of this study was to test the short term prognostic value of sST2 compared with hs-cTnI in patients with chest pain.
Methods: Assays for hs-cTnI and sST2 were performed in 157 patients admitted to the Emergency Department (ED) for chest pain at arrival. In-hospital and 30-day follow-up mortalities were assessed.
Results: The incidence of ACS was 37%; 33 patients were diagnosed with ST elevation myocardial infarction (STEMI), and 25 were diagnosed with non-ST elevation myocardial infarction (NSTEMI). Compared with the no acute coronary syndrome (NO ACS) group, the median level of hs-cTnI was higher in ACS patients: 7.22 (5.24-14) pg/mL vs 68 (15.33 -163.50) pg/mL (P<0.0001). In all patients, the sST2 level at arrival showed higher independent predictive power than hs-cTnI (odds ratio [OR] 20.13, P<0.0001 and OR 2.61, P<0.0008, respectively). sST2 at ED arrival showed a greater prognostic value for cardiovascular events in STEMI (area under the curve [AUC] 0.80, P<0.001) than NSTEMI patients (AUC 0.72, P<0.05). Overall, 51% of the STEMI patients with an sST2 value>35 ng/mL at ED arrival died during the 30-day follow-up.
Conclusions: sST2 has a greater prognostic value for 30-day cardiac mortality after discharge in patients presenting to the ED for chest pain compared with hs-cTnI. In STEMI patients, an sST2 value >35 ng/mL at ED arrival showed the highest predictive power for short-term mortality.
Keywords: Emergency Department, Chest pain, Acute coronary syndrome, hs-cTnI, sST2, 30 day mortality, Prognosis


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