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Elevated serum osteoprotegerin levels measured early after acute ST-elevation myocardial infarction predict final infarct size
  1. Geir Øystein Andersen1,2,3,
  2. Eva Cecilie Knudsen1,2,3,
  3. Pål Aukrust4,5,6,
  4. Arne Yndestad3,4,
  5. Erik Øie3,4,7,
  6. Carl Müller8,
  7. Ingebjørg Seljeflot1,2,3,6,
  8. Thor Ueland4,9
  1. 1Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway
  2. 2Center for Clinical Heart Research, Oslo University Hospital Ulleval, Oslo, Norway
  3. 3Center for Heart Failure Research, University of Oslo, Oslo, Norway
  4. 4Research Institute for Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
  5. 5Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Oslo, Norway
  6. 6Faculty of Medicine, University of Oslo, Oslo, Norway
  7. 7Medical Department, Diakonhjemmet Hospital, Oslo, Norway
  8. 8Department of Nuclear Medicine, Oslo University Hospital Ulleval, Oslo, Norway
  9. 9Section of Endocrinology, Oslo University Hospital Rikshospitalet, Oslo, Norway
  1. Correspondence to Dr Geir Øystein Andersen, Department of Cardiology, Oslo University Hospital Ulleval, N 0541 Oslo, Norway; g.o.andersen{at}


Background Increased serum osteoprotegerin has been shown to be associated with increased mortality and heart failure development in patients with acute coronary syndromes. The aim of the present study was to elucidate a possible association between serum osteoprotegerin measured acutely in patients with ST-elevation myocardial infarction (STEMI) and final infarct size.

Methods Serum osteoprotegerin was measured in fasting blood samples from 199 patients with acute STEMI, sampled at a median time of 16 h after primary percutaneous coronary intervention (PCI). After 3 months, final infarct size (in percentage of left ventricular mass; LVM) was assessed by single-photon emission CT. The outcome variable final infarct size was dichotomised using the 75th percentile as the cutoff value (large infarct size ≥29.0%). A multivariable analysis was performed adjusting for multiple clinical and biochemical covariates.

Results Median (IQR) osteoprotegerin concentration was 1.4 (1.0, 2.1) ng ml−1 and patients with high osteoprotegerin level (> median) at baseline had larger infarct size at 3 months compared with patients with low osteoprotegerin levels (< median) (25 (8, 40) vs 6 (0, 19)% of LVM, respectively, p<0.0001). A high osteoprotegerin level was also associated with an approximately sevenfold increase in the odds of developing a large myocardial infarct (OR 7.0; 3.2, 15.5, p<0.001). After adjustment for potential confounders including peak troponin T, the adjusted OR was 5.2 (2.0, 13.1) p<0.001.

Conclusion High levels of circulating osteoprotegerin measured the first morning after a PCI-treated acute STEMI were strongly associated with final infarct size.

  • Final infarct size
  • inflammation
  • myocardial infarction
  • osteoprotegerin

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  • Funding The south-eastern Norway regional health authority supported this work.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the national committees for research ethics, Norway.

  • Provenance and peer review Not commissioned; externally peer reviewed.