Elevated baseline serum sST2 levels were associated with adverse long-term clinical outcomes in an unselected, real-world cohort of patients undergoing PCI.
Key Findings
Results
Patients with higher sST2 levels had significantly higher rates of MACCEs compared to those with lower sST2 levels.
MACCEs occurred in 4.2% of patients in the high sST2 group vs. 0.8% in the low sST2 group (p = 0.005)
Patients were stratified according to the median sST2 value of 28.3 ng/mL
Total of 758 consecutive PCI patients enrolled between September 2015 and November 2017
MACCEs were defined as a composite of cardiac death, nonfatal myocardial infarction, and nonfatal stroke
Overall, MACCEs occurred in 19 patients (2.5%) during a median follow-up of 28.3 months
Results
Patients with higher sST2 levels had significantly higher rates of all-cause mortality compared to those with lower sST2 levels.
All-cause mortality was 11.9% in the high sST2 group vs. 2.6% in the low sST2 group (p < 0.001)
The difference in all-cause mortality was more pronounced than the difference in MACCEs between groups
Follow-up duration had a median of 28.3 months
Results
The association between elevated sST2 and MACCE was attenuated and became statistically non-significant after multivariable adjustment.
Adjusted hazard ratio for MACCE was 3.28 (95% confidence interval, 0.91–11.83; p = 0.070)
Analysis was performed using multivariable Cox proportional hazards models
The attenuation after adjustment suggests confounding by other clinical variables
Results
sST2 demonstrated moderate predictive performance for both MACCE and all-cause mortality on receiver operating characteristic analysis.
AUC for predicting MACCE was 0.723
AUC for predicting all-cause mortality was 0.763
The optimal cutoff value for predicting MACCE was 52.2 ng/mL
The median sST2 level used for group stratification was 28.3 ng/mL, notably lower than the optimal predictive cutoff
Methods
The study enrolled an unselected, real-world cohort of 758 consecutive patients with coronary artery disease undergoing PCI.
Enrollment occurred between September 2015 and November 2017
Baseline serum sST2 levels were measured before PCI
The study population was described as consecutive and unselected, representing a real-world clinical setting
Median follow-up duration was 28.3 months
What This Means
This research suggests that a blood protein called soluble ST2 (sST2), which is linked to heart stress, inflammation, and scarring, may help predict which patients undergoing a heart artery-opening procedure called percutaneous coronary intervention (PCI) are at higher risk for serious future cardiac events. The study followed 758 real-world patients for about two and a half years and found that those with higher sST2 levels before their procedure were more likely to experience major adverse cardiac or cerebrovascular events (about 4% vs. less than 1%) and were much more likely to die from any cause (nearly 12% vs. about 3%) compared to patients with lower sST2 levels. A blood level of 52.2 ng/mL was identified as the best cutoff for predicting future adverse events.
However, when researchers accounted for other health factors that might influence outcomes, the relationship between high sST2 and major cardiac events was no longer statistically significant, meaning other factors may explain some of the increased risk. Despite this, sST2 still showed moderate ability to distinguish between patients who would and would not experience bad outcomes, with accuracy scores (AUC) of 0.72 for cardiac events and 0.76 for death from any cause.
This research suggests that measuring sST2 before PCI could provide useful prognostic information in everyday clinical practice, potentially helping identify higher-risk patients who may need closer monitoring or more aggressive treatment. The authors note that larger studies are needed to confirm whether sST2 should be routinely used as a risk marker in this patient population.
Byeon J, Song Y, Roh K, Kim K, Kim S, Kim Y, et al.. (2026). Association Between Baseline Soluble ST2 Levels and Long-Term Outcomes After Percutaneous Coronary Intervention.. Medicina (Kaunas, Lithuania). https://doi.org/10.3390/medicina62081563