Objective To investigate the relationship between plasma fetuin-A, an anti-inflammatory glycoprotein which might be involved in myocardial healing after acute infarction, and infarct size, left ventricular (LV) function and dimensions as well as the occurrence of adverse remodelling at 4 months after acute ST segment elevation myocardial infarction (STEMI).

Methods In this single-centre prospective, observational study, 89 patients underwent cardiac MR within the first week and 4 months after mechanical reperfusion for first STEMI. Infarct size, LV function and dimensions were assessed at both time points. Fetuin-A levels were determined from blood samples drawn at a median of 49 h (IQR 30–59 h) after STEMI by an immunofluorescent assay.

Results Fetuin-A levels (median 568 µg/mL, IQR 478–763 µg/mL) were significantly correlated with infarct size and LV ejection fraction at baseline and follow-up (all p<0.05). Moreover, fetuin-A was related to the increase in the end-diastolic volume index (r=−0.383, p<0.001). According to multivariate logistic regression analysis, fetuin-A concentrations (HR=0.17, 95% CI 0.03 to 0.89, p=0.036) besides the presence of late microvascular obstruction (HR=10.03, 95% CI 0.98 to 102.43, p=0.05) were significantly related to the occurrence of adverse LV remodelling at 4 months.

Conclusions Circulating fetuin-A at day 2 after STEMI is related to acute and chronic infarct size, LV function and dimensions. In addition, it might be useful to identify patients at increased risk for adverse LV remodelling.