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Multimarker risk strategy for predicting 1-month and 1-year major events in non-ST-elevation acute coronary syndromes
Vicent Bodí1, Juan Sanchis, Angel Llàcer
1Servei de Cardiología, Hospital Clínic i Universitari, Universitat de València, València, Spain. vicentbodi@hotmail.com
Insights
Predicting major events in non-ST elevation acute coronary syndromes is improved by measuring multiple biomarkers. A simple score based on elevated troponin I, myoglobin, C-reactive protein, fibrinogen, and homocysteine effectively predicts risk.
Area of Science:
- Cardiology
- Biomarker Discovery
- Risk Stratification
Background:
- Non-ST elevation acute coronary syndromes (NSTE-ACS) require accurate risk prediction for optimal patient management.
- Current risk assessment may benefit from integrating multiple prognostic markers.
Purpose of the Study:
- To evaluate the combined utility of troponin I, myoglobin, C-reactive protein, fibrinogen, and homocysteine in predicting major adverse events in NSTE-ACS patients.
- To determine if a composite biomarker score enhances risk stratification.
Main Methods:
- Prospective analysis of 557 NSTE-ACS patients.
- Measurement of troponin I, myoglobin, high-sensitivity C-reactive protein, fibrinogen, and homocysteine.
- Analysis of major events (death or nonfatal myocardial infarction) at 1-month and 1-year follow-up.
Main Results:
- C-reactive protein and myoglobin were associated with 1-month major events.
- Troponin I, C-reactive protein, and homocysteine predicted 1-year major events.
- A simple score based on the number of elevated biomarkers demonstrated significant adjusted risk for major events at both 1 month (1.6 [1.3-1.9]) and 1 year (1.4 [1.2-1.7]).
Conclusions:
- Individual biomarkers of myocardial damage, inflammation, and homocysteine offer prognostic value in NSTE-ACS.
- The cumulative number of elevated biomarkers serves as an independent and powerful predictor of major adverse events.
Background:
The aim of this study was to define the utility of the combined measurement of troponin I, myoglobin, C-reactive protein, fibrinogen, and homocysteine to predict risk in non-ST elevation acute coronary syndromes.
Methods:
Troponin I, myoglobin, high-sensitivity C-reactive protein, fibrinogen, and homocysteine were measured in 557 consecutive patients admitted to our institution for non-ST elevation acute coronary syndrome. The risk for major events (death or nonfatal myocardial infarction) at first month and at first year follow-up was analyzed.
Results:
In a multivariate model adjusting for baseline characteristics and electrocardiographic changes, the only biomarkers related to major events at first month were C-reactive protein (P = .007) and myoglobin (P = .02), and at first year troponin I (P = .02), C-reactive protein (P = .03), and homocysteine (P = .04). The rate of major events depending on the number (0-5) of elevated biomarkers were at first month: 4.1%, 3.7%, 5.7%, 6.1%, 6.5%, and 30.8% (P < .0001), and at first year: 8.2%, 11.1%, 12.3%, 16.2%, 23.7%, and 50% (P < .0001). A simple score including the number of elevated biomarkers showed an adjusted risk of major events of 1.6 [1.3-1.9] at first month and of 1.4 [1.2-1.7] at first year.
Conclusions:
Markers of myocardial damage, inflammation, and homocysteine analyzed separately provide prognostic information. The number of elevated biomarkers is an independent risk predictor of major events.
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