Increased serum nardilysin is associated with worse long-term outcome of ST-elevation myocardial infarction

OBJECTIVE: Nardilysin (N-arginine dibasic convertase, NRDC) is a kind of metalloendopeptidase associated with several inflammatory diseases. NRDC is reported to be eligible for early detection of acute coronary syndrome. However, the availability and effectiveness of NRDC in predicting the prognosis of patients with ST-elevation myocardial infarction has never been investigated. PATIENTS AND METHODS: From January 2010 to January 2012, the prospective observational cohort study enrolled a total of 396 STEMI patients, who were sampled with blood within 24 hours after admission. A long-term follow-up was conducted to record the primary endpoint of all-cause mortality, as well as secondary endpoint of myocardial infarction, stroke, emergent revascularization and admission due to heart failure. Hazard ratio (HR) related to the serum NRDC level was estimated by Cox regression model. RESULTS: The enrolled patients completed the follow-up with an average of 4.6 +/- 0.5 years, of whom 24 patients died (primary endpoint, 6.1%), while 89 episodes of secondary endpoints occurred (22.5%). Patients with highest quartile level of NRDC (Q4 level, > 2041 pg/ml) were subjected to higher risk of all-cause death [HR 3.973, 95% CI (1.648-9.575), p = 0.002] compared to patients with lower three quartiles level of NRDC (Q1 to Q3, < 2041 pg/ml), while there was no difference in adverse events (p = 0.403). CONCLUSIONS: The increased serum NRDC level at admission is associated with a higher risk of all-cause mortality for ST-elevation myocardial infarction patients.