Osteoprotegerin and Cardiovascular Mortality in Patients With Non-ST Elevation Acute Coronary Syndromes

Study Questions:

What is the relationship between osteoprotegerin (OPG) levels and cardiovascular (CV) complications following acute coronary syndrome (ACS) presentation?


This was a biomarker substudy of 4,463 patients from the MERLIN-TIMI 36 trial (placebo vs. ranolazine in non-ST elevation ACS [NSTE-ACS]).


During a median follow-up of 341 days, 208 patients died of CV causes. OPG concentrations were associated with both 30-day and 1-year incidence of CV death. After adjustment for conventional risk markers, OPG concentrations remained a significant predictor of CV death by 30 days (hazard ratio [HR], 2.32; p = 0.005) and 1 year (HR, 1.85; p < 0.001). OPG levels were also predictive of new or worsening heart failure (HF) at 30 days (HR, 2.25; p = 0.001) and 1 year (HR 1.81; p = 0.001). Although OPG levels were associated with recurrent myocardial infarction within 12 months, this association was no longer significant after multivariable adjustment.


The authors concluded that OPG is independently associated with 30-day and 1-year risk of CV mortality and HF development after NSTE-ACS.


OPG levels have previously been associated with atherosclerotic vascular disease. Some studies have also demonstrated an association of OPG levels with left ventricular dysfunction and progression to HF. The current study is illuminating in that while no strong relationship between OPG and ischemic events was identified, OPG levels were predictive of HF along with early and late mortality following NSTE-ACS, suggesting that associations between adverse CV outcomes and OPG levels may be driven primarily by myocardial dysfunction. The utility of OPG levels in guiding management of ACS patients will require further study.

Clinical Topics: Acute Coronary Syndromes, Heart Failure and Cardiomyopathies, ACS and Cardiac Biomarkers, Acute Heart Failure, Heart Failure and Cardiac Biomarkers

Keywords: Acute Coronary Syndrome, Biological Markers, Osteoprotegerin, Heart Failure

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