Risk Assessment after ST-Segment Elevation Myocardial Infarction: Can Biomarkers Improve the Performance of Clinical
Alvaro Garcia-Osuna1,2, Jordi Sans-Rosello3, Andreu Ferrero-Gregori3
1Department of Clinical Biochemistry, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain.
Insights
New cardiac biomarkers, growth differentiation factor 15 (GDF-15) and N-terminal fragment of probrain natriuretic peptide (NT-proBNP), significantly enhance risk assessment for ST-segment elevation myocardial infarction (STEMI) patients. These biomarkers improve prediction of mortality and major adverse cardiac events, aiding personalized treatment strategies.
Area of Science:
- Cardiovascular Medicine
- Biomarker Discovery
- Clinical Risk Stratification
Background:
- ST-segment elevation myocardial infarction (STEMI) carries a high risk of morbimortality, necessitating accurate risk assessment for personalized patient management.
- Current clinical scores for STEMI risk stratification have limitations in capturing the full spectrum of patient risk.
Purpose of the Study:
- To evaluate the efficacy of novel cardiac biomarkers, individually and in combination, for improving short- and long-term risk stratification in STEMI patients.
- To determine if a multibiomarker model or association with clinical variables enhances the prognostic accuracy beyond existing methods.
Main Methods:
- Retrospective observational study involving 253 STEMI patients undergoing angiography.
- Assessed biomarkers included CT-IGFBP4, hs-cTnT, NT-proBNP, and GDF-15, reflecting diverse cardiovascular physiopathological pathways.
- Evaluated in-hospital and 2-year follow-up mortalities (cardiovascular and all-cause) and major adverse cardiac events (MACE), alongside discrimination, calibration, and reclassification.
Main Results:
- Biomarkers demonstrated significant prognostic ability for mortality prediction, both alone and within a multibiomarker model.
- A clinical model incorporating age, Killip-Kimball class, eGFR, and heart rate was developed.
- GDF-15 and NT-proBNP significantly improved the risk assessment of the clinical model for most endpoints, enhancing discrimination, calibration, and reclassification.
Conclusions:
- Growth differentiation factor 15 (GDF-15) and N-terminal fragment of probrain natriuretic peptide (NT-proBNP) add significant value to the conventional risk assessment of STEMI patients.
- The combination of NT-proBNP and hs-cTnT specifically improved the prediction of cardiovascular mortality.
- These findings support the integration of GDF-15 and NT-proBNP into risk stratification strategies for STEMI management.
Introduction:
Myocardial infarction with ST-segment elevation (STEMI) is the coronary artery disease associated with the highest risk of morbimortality; however, this risk is heterogeneous, usually being evaluated by clinical scores. Risk assessment is a key factor in personalized clinical management of patients with this disease.
Aim:
The aim of this study was to assess whether some new cardiac biomarkers considered alone, combined in a multibiomarker model or in association with clinical variables, improve the short- and long-term risk stratification of STEMI patients.
Materials And Methods:
This was a retrospective observational study of 253 patients with STEMI. Blood samples were obtained before or during the angiography. The assessed biomarkers were C-terminal fragment of insulin-like growth factor binding protein-4 (CT-IGFBP4), high sensitive cardiac troponin T (hs-cTnT), N-terminal fragment of probrain natriuretic peptide (NT-proBNP), and growth differentiation factor 15 (GDF-15); they reflect different cardiovascular (CV) physiopathological pathways and underlying pathologies. We registered in-hospital and follow-up mortalities and their causes (cardiovascular and all-cause) and major adverse cardiac events (MACE) during a two year follow-up. Discrimination, survival analysis, model calibration, and reclassification of the biomarkers were comprehensively evaluated.
Results And Discussion:
In total, 55 patients (21.7%) died, 33 in-hospital and 22 during the follow-up, most of them (69.1%) from CV causes; 37 MACE occurred during follow-up. Biomarkers showed good prognostic ability to predict mortality, alone and combined with the multibiomarker model. A predictive clinical model based on age, Killip-Kimball class, estimated glomerular filtration rate (eGFR), and heart rate was derived by multivariate analysis. GDF-15 and NT-proBNP significantly improved risk assessment of the clinical model, as shown by discrimination, calibration, and reclassification of all the end-points except for all-cause mortality. The combination of NT-proBNP and hs-cTnT improved CV mortality prediction.
Conclusions:
GDF-15 and NT-proBNP added value to the usual risk assessment of STEMI patients.
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