Abstract
BACKGROUND: Although early mortality rates have decreased following reperfusion therapies such as percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI), they remain at risk for major adverse cardiovascular events (MACE). Heparanase (HPSE) is an endogenous β-D-glucuronosidase and plays a key role in inflammation and vascular remodeling. This study investigated the predictive value of HPSE for MACE after STEMI. METHODS: This prospective observational study included 207 consecutive STEMI patients who received primary PCI. Coronary blood was collected 10 min after balloon dilation. Coronary HPSE levels were measured by enzyme-linked immunosorbent assay (ELISA). Patients were followed for 6 months to record the occurrence of MACE. RESULTS: During the 6-month follow-up period, 53 patients (25.6%) experienced MACE. Patients who experienced MACE had significantly higher coronary HPSE levels than those without (5.08 ± 1.27 ng/mL vs. 3.68 ± 1.20 ng/mL, P < 0.001). In multivariate Cox regression analysis, after adjusting for established risk factors, elevated HPSE levels remained an independent predictor of MACE (HR = 1.693, 95% CI: 1.323-2.165, P < 0.001). ROC analysis showed that a combined HPSE and GRACE model predicted MACE with an AUC of 0.849 (95% CI: 0.787-0.911, P < 0.001). Kaplan-Meier analysis revealed significantly lower MACE-free survival in the high HPSE group (log-rank P < 0.001). CONCLUSION: Coronary HPSE is an independent predictor of 6-month MACE in STEMI patients. It also enhances the predictive capability of the GRACE score. Because of this, HPSE serves as a promising biomarker that can help doctors assess risk more accurately and guide clinical decisions.