Biomarker-Based Prediction of Recurrent Ischemic Events in Patients With Acute Coronary Syndromes
Gorav Batra1, Johan Lindbäck2, Richard C Becker3
1Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
Insights
A new ABC-ACS ischemia score predicts cardiovascular death and myocardial infarction risk in acute coronary syndrome (ACS) patients post-percutaneous coronary intervention. Biomarkers significantly improved risk prediction, aiding clinical decision-making.
Area of Science:
- Cardiology
- Biomarker Discovery
- Clinical Risk Prediction
Background:
- Patients with acute coronary syndrome (ACS) face ongoing risk of ischemic events.
- Accurate risk stratification is crucial for managing residual risk in ACS patients.
Purpose of the Study:
- To develop and validate a biomarker-based prediction model for 1-year risk of cardiovascular (CV) death and myocardial infarction (MI) in ACS patients.
- To identify key predictors, including novel biomarkers, for improved risk assessment.
Main Methods:
- Utilized data from 10,713 patients in the PLATO trial (development) and 3,508 in the TRACER trial (validation).
- Employed Cox regression models to assess risk variables and derived a simplified score.
- Included biomarkers (GDF-15, NT-proBNP) and clinical factors in the model.
Main Results:
- The ABC-ACS ischemia score, incorporating age, biomarkers (GDF-15, NT-proBNP), and clinical variables, demonstrated good calibration and discrimination.
- C-indices for CV death/MI were 0.71 (development) and 0.72 (validation).
- The score showed even better performance for CV death prediction (C-indices 0.80 and 0.84).
Conclusions:
- An 8-item ABC-ACS ischemia score was successfully developed and validated for predicting CV death/MI in ACS patients undergoing PCI.
- The score offers good calibration and discrimination, potentially aiding risk prediction and clinical decision support.
- Biomarkers GDF-15 and NT-proBNP were identified as highly valuable predictors of ischemic events in ACS.
Background:
In patients with acute coronary syndrome (ACS), there is residual and variable risk of recurrent ischemic events.
Objectives:
This study aimed to develop biomarker-based prediction models for 1-year risk of cardiovascular (CV) death and myocardial infarction (MI) in patients with ACS undergoing percutaneous coronary intervention.
Methods:
We included 10,713 patients from the PLATO (A Comparison of Ticagrelor [AZD6140] and Clopidogrel in Patients With Acute Coronary Syndrome) trial in the development cohort and externally validated in 3,508 patients from the TRACER (Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome) trial. Variables contributing to risk of CV death/MI were assessed using Cox regression models, and a score was derived using subsets of variables approximating the full model.
Results:
There were 632 and 190 episodes of CV death/MI in the development and validation cohorts. The most important predictors of CV death/MI were the biomarkers, growth differentiation factor 15, and N-terminal pro-B-type natriuretic peptide, which had greater prognostic value than all candidate variables. The final model included 8 items: age (A), biomarkers (B) (growth differentiation factor 15 and N-terminal pro-B-type natriuretic peptide), and clinical variables (C) (extent of coronary artery disease, previous vascular disease, Killip class, ACS type, P2Y12 inhibitor). The model, named ABC-ACS ischemia, was well calibrated and showed good discriminatory ability for 1-year risk of CV death/MI with C-indices of 0.71 and 0.72 in the development and validation cohorts, respectively. For CV death, the score performed better, with C-indices of 0.80 and 0.84 in the development and validation cohorts, respectively.
Conclusions:
An 8-item score for the prediction of CV death/MI was developed and validated for patients with ACS undergoing percutaneous coronary intervention. The ABC-ACS ischemia score showed good calibration and discrimination and might be useful for risk prediction and decision support in patients with ACS. (A Comparison of Ticagrelor [AZD6140] and Clopidogrel in Patients With Acute Coronary Syndrome [PLATO]; NCT00391872; Trial to Assess the Effects of Vorapaxar [SCH 530348; MK-5348] in Preventing Heart Attack and Stroke in Participants With Acute Coronary Syndrome [TRACER]; NCT00527943).
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