Temporal biomarker concentration patterns during the early course of acute coronary syndrome
Kai M Eggers1,2, Gorav Batra1,2, Bertil Lindahl1,2
1Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
Insights
Temporal biomarker patterns in acute coronary syndrome (ACS) vary by biomarker type and patient sex. Considering time from symptom onset is crucial for accurate interpretation of cardiac biomarker results in ACS patients.
Area of Science:
- Cardiovascular Medicine
- Biomarker Discovery
- Clinical Diagnostics
Background:
- Biomarkers in acute coronary syndrome (ACS) offer insights into myocardial necrosis, hemodynamic stress, and inflammation.
- Limited data exists on early temporal biomarker patterns in ACS, especially for multiple biomarkers simultaneously.
Purpose of the Study:
- To investigate temporal concentration patterns of multiple biomarkers early during ACS.
- To explore associations between biomarker levels and time from symptom onset in ACS patients.
Main Methods:
- Measured high-sensitivity cardiac troponin T (hs-cTnT), hs-cTnI, NT-proBNP, CRP, and GDF-15 in ACS patients from the PLATO trial.
- Utilized linear regression and interaction analyses to model temporal biomarker patterns and their association with time from symptom onset.
Main Results:
- All biomarkers, except GDF-15, showed significant associations with time from symptom onset (p<0.001).
- Concentration increases were more pronounced in ST-elevation myocardial infarction (STEMI) than non-ST-elevation ACS (NSTE-ACS).
- Temporal patterns for hs-cTnT and hs-cTnI differed by sex, while other biomarkers showed similar patterns across age and sex cohorts.
Conclusions:
- Temporal biomarker patterns in early ACS reflect varying pathophysiological processes and myocardial injury.
- Time from symptom onset is a critical factor for interpreting biomarker results in ACS.
- Sex-specific temporal patterns exist for certain cardiac biomarkers in ACS.
Objectives:
Biomarker concentrations and their changes during acute coronary syndrome (ACS) provide clinically useful information on pathophysiological processes, e.g. myocardial necrosis, hemodynamic stress and inflammation. However, current evidence on temporal biomarker patterns early during ACS is limited, and studies investigating multiple biomarkers are lacking.
Methods:
We measured concentrations of high-sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI), NT-terminal pro-B-type natriuretic peptide, C-reactive protein, and growth-differentiation factor-15 (GDF-15) in plasma samples obtained at randomization in ACS patients from the PLATelet inhibition and patient Outcomes (PLATO) trial. Linear regressions with interaction analyses were used to investigate the associations of biomarker concentrations with the time from symptom onset and to model temporal biomarker concentration patterns.
Results:
The study population consisted of 16,944 patients (median age 62 years; 71.3 % males) with 6,853 (40.3 %) having ST-elevation myocardial infarction (STEMI) and 10,141 (59.7 %) having non-ST-elevation ACS (NSTE-ACS). Concentrations of all biomarkers were associated with time from symptom onset (pinteraction<0.001), apart for GDF-15 (pinteraction=0.092). Concentration increases were more pronounced in STEMI compared to NSTE-ACS. Temporal biomarker patterns for hs-cTnT and hs-cTnI were different depending on sex whereas biomarker patterns for the other biomarkers were similar in cohorts defined by age and sex.
Conclusions:
Temporal concentration patterns differ for various biomarkers early during ACS, reflecting the variability in the activation and duration of different pathophysiological processes, and the amount of injured myocardium. Our data emphasize that the time elapsed from symptom onset should be considered for the interpretation of biomarker results in ACS.
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