Multimarker Risk Strategy for Predicting 1-Month
Multimarker Risk Strategy for Predicting 1-Month
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.
There is solid evidence from numerous studies that the unstable patient with elevated troponin or myoglobin has an increased risk of myocardial infarction or death. Markers of inflammation such as C-reactive protein and fibrinogen have been shown to be helpful in predicting the long-term prognosis of these patients. Finally, homocysteine has been related to a major risk of coronary thrombosis and infarction. Interestingly, these biomarkers are frequently measured in our environment; they assess different pathophysiological mechanisms, but little is known about the prognostic usefulness of a combined determination. We aimed to investigate whether a multimarker approach by means of an assessment of all 5 biomarkers would provide independent information for predicting short-term and long-term risks in non–ST elevation acute coronary syndromes.
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.
There is solid evidence from numerous studies that the unstable patient with elevated troponin or myoglobin has an increased risk of myocardial infarction or death. Markers of inflammation such as C-reactive protein and fibrinogen have been shown to be helpful in predicting the long-term prognosis of these patients. Finally, homocysteine has been related to a major risk of coronary thrombosis and infarction. Interestingly, these biomarkers are frequently measured in our environment; they assess different pathophysiological mechanisms, but little is known about the prognostic usefulness of a combined determination. We aimed to investigate whether a multimarker approach by means of an assessment of all 5 biomarkers would provide independent information for predicting short-term and long-term risks in non–ST elevation acute coronary syndromes.