ST2 has diagnostic and prognostic utility for all-cause mortality and heart failure in patients presenting to the emergency department with chest pain

Journal of Cardiac Failure, 04/06/2012

ST2 was more specific for acute heart failure than BNP. ST2 is independently predictive of future death and/or heart failure and has incremental utility in combination with BNP.


  • From November 2007 to April 2010, 995 patients attending the Emergency Department with chest pain were prospectively recruited.
  • Troponin I (TnI), B–type natriuretic peptide (BNP), creatine kinase–myocardial band (CKMB), myoglobin, and ST2 were measured at 0 and 2 hours.
  • The diagnostic utility of ST2 for heart failure and prognostic utility for primary outcome of death and/or heart failure by 18 months was assessed.
  • Elevated ST2 had sensitivity 73.5% (55.8%–86.4%) and specificity 79.6% (79.0%–80.1%) for acute heart failure (n = 34) [compared with BNP sensitivity 88.2% (73.6%–95.3%), specificity 66.2% (65.7%–66.4%)].
  • Elevated ST2 conveyed risk of 18–month primary outcome (n = 110), with an adjusted hazard ratio (HR) of 1.9 (1.2–3.2), compared with BNP HR 2.8 (1.4–5.7), myoglobin HR 1.9 (1.1–3.3), TnI HR 1.7 (1.0–2.7), and CKMB HR 0.9 (0.5–1.7).


  • When ST2 and BNP were both elevated, risk was greater than if either marker was elevated in isolation (P < .001).

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