The diagnostic and prognostic value of growth stimulation expressed gene 2 in patients with coronary artery disease
Y Y Qu, Y J Zhang, J D Ding, G S MaAbstract
Background
Cardiovascular disease has become the leading cause of death worldwide. The invasiveness and associated risks of traditional diagnostic methods, such as imaging and coronary angiography, limit their utility for early diagnosis and prognosis prediction. Our previous study had confirmed that growth stimulation expressed gene 2 (ST2) presented fundamental values in diagnosing coronary artery disease (CAD), providing early warning of myocardial infarction and reflecting prognosis of critically ill patients with CAD.
Methods
We retrospectively recruited 7228 CAD patients undergoing coronary angiography and ST2 examination from January 2022 to July 2025. These patients were divided into four groups as coronary atherosclerosis group, coronary heart disease (CHD) group, non-ST-segment elevation myocardial infarction (NSTEMI) group and ST-segment elevation myocardial infarction (STEMI) group according to the results of coronary angiography and other examinations.
Results
In coronary atherosclerosis group (313 males and 535 females), we found that the level of ST2 was higher in males than in females (20.98 ± 17.02 ng/mL vs. 16.27 ± 14.12 ng/mL, P=0.025). However, age-related difference wasn’t observed among age subgroups (≤50yrs, 51-74yrs, ≥75yrs). Significant difference of ST2 expression was observed among the four disease groups as ST2 level were 19.71 ± 23.29 ng/mL, 23.32 ± 27.04 ng/mL, 44.20 ± 55.99 ng/mL and 67.79 ± 80.61 ng/mL for coronary atherosclerosis group, CHD group, NSTEMI group and STEMI group (P<0.001). Patients undergoing in-hospital rescue also presented with higher level of ST2 compared those CAD patients with stable condition (23.10 ± 26.74 ng/mL vs. 55.15 ± 69.59 ng/mL, P<0.001). What’s more, in 412 critically ill patients with CAD, patients being successfully rescued were more likely to have lower level ST2 compared with those unsuccessfully resuscitated patients (64.46 ± 74.91 ng/mL vs. 84.95 ± 76.28 ng/mL, P<0.001). Using receiver operating characteristic (ROC) curve analysis, the optimal cutoff value of ST2 for discriminating coronary atherosclerosis from CHD and myocardial infarction was 14.55 ng/mL, with a sensitivity of 69.9% and a specificity of 51.8% (AUC = 0.642, 95% CI: 0.622–0.661, P<0.001). The optimal cutoff value of ST2 for discriminating coronary atherosclerosis and CHD from myocardial infarction was 26.75 ng/mL, with a sensitivity of 58.1% and a specificity of 78.2% (AUC = 0.732, 95% CI: 0.712–0.751, P<0.001).
Conclusion
ST2 levels differ by gender, degree of coronary artery stenosis and severity of illness. It could be used as a promising biomarker to not only distinguish coronary atherosclerosis from CHD and myocardial infarction, but also distinguish coronary atherosclerosis and CHD from myocardial infarction, which may facilitate the diagnosis and prognosis assessment of CAD in routine clinical practice.comparisons between/among groupsdiagnostic value of ST2