Related Experiment Videos
Cardiac markers and risk stratification: an integrated approach
M Galvani1, D Ferrini, F Ghezzi
1Cardiovascular Research Unit, Fondazione Sacco, Forlì, Italy. galvanim@tin.it
Insights
This study assessed biochemical markers for acute coronary syndromes (ACS) risk. Cardiac troponins, D-dimer, and C-reactive protein help predict major cardiac events in ACS patients.
Area of Science:
- Cardiology
- Biomarker Research
- Clinical Risk Stratification
Background:
- Accurate risk stratification in acute coronary syndromes (ACS) is crucial for resource allocation and treatment optimization.
- Existing clinical and electrocardiographic indicators have limitations in predicting major cardiac events.
- Biomarkers offer complementary information, but their independent prognostic value in unselected ACS patients requires further investigation.
Purpose of the Study:
- To prospectively evaluate the prognostic value of various biochemical markers in a broad spectrum of ACS patients.
- To determine if biomarkers of myocardial damage, hemostasis, and inflammation add independent prognostic information beyond clinical and electrocardiographic data.
- To compare the prognostic utility of different biomarkers in predicting adverse outcomes in ACS.
Main Methods:
- The Early Prognostic Value of Biochemical Markers of Myocardial Damage, Activation of Hemostatic Mechanism and Inflammation in Acute Ischemic Syndromes (EMAI) study prospectively enrolled 1971 ACS patients.
- Patients were admitted to 31 Italian Coronary Care Units with rest anginal pain and ECG evidence of ischemia.
- Measured biomarkers included cardiac troponin I (cTnI), cardiac troponin T (cTnT), D-dimer, prothrombin fragment 1+2 (F1+2), thrombin-antithrombin complex (TAT), and C-reactive protein (CRP).
Main Results:
- Elevations in cardiac troponin I (cTnI) and cardiac troponin T (cTnT) were strongly associated with a high-risk profile.
- The study evaluated the prognostic value of cTnI, cTnT, D-dimer, F1+2, TAT, and CRP in ACS patients.
- The primary outcome of death or non-fatal myocardial infarction (MI) within 30 days occurred in 8.9% of the study population.
Conclusions:
- Biomarkers like cardiac troponins provide significant prognostic information in ACS patients.
- Further analysis is needed to clarify the independent contribution of hemostasis and inflammation markers to risk stratification in ACS.
- The EMAI study provides valuable data on the role of biochemical markers in managing ACS patients.
Abstract:
Risk stratification of patients with acute coronary syndromes (ACS) is pivotal for correct allocation of health resources and for maximizing the benefit of available treatment modalities. However, clinical and electrocardiographic indicators of high risk lack sufficient sensitivity for the detection of major cardiac events. The complementary information provided by the measurement of different biomarkers is believed to be very useful. Specifically, elevations of cardiac troponin I (cTnI) and T (cTnT) are strongly associated with a high-risk profile both at short- and long-term. This has been definitely demonstrated in many studies as well as in cumulative meta-analysis. The role of different biomarkers, such as those reflecting activation of hemostasis and the presence of inflammation, is however less defined. At the moment, no study has prospectively evaluated these biomarkers in the whole spectrum of unselected patients with ACS. It is also unclear whether these biomarkers add independent prognostic value to the clinical and electrocardiographic indicators of adverse outcome and whether they offer additional information when compared to each other. The Early Prognostic Value of Biochemical Markers of Myocardial Damage, Activation of Hemostatic Mechanism and Inflammation in Acute Ischemic Syndromes (EMAI) study has been prospectively designed to solve these issues. In this study, we have evaluated the prognostic value of cTnI and cTnT, D-dimer, prothrombin fragment 1+2 (F1+2), thrombin-antithrombin complex (TAT) and C-reactive protein (CRP) in patients with ACS at the time of admission. We have enrolled in 31 Italian Coronary Care Units 1971 patients with rest anginal pain within 12 h from admission and electrocardiographic evidence of myocardial ischemia. Of these, 730 patients resulted to have ST-segment elevation myocardial infarction eligible for a reperfusion strategy and 1241, an acute coronary syndrome without persisting ST-segment elevation. Primary outcome measure of the study is the composite of death and non-fatal MI within 30 days from admission, which has occurred in 8.9% of the study population.