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A multimarker risk stratification approach to non-ST elevation acute coronary syndrome: implications of troponin T, CRP, NT pro-BNP and fibrin D-dimer levels.
J Intern Med 2007; 262(6):651-8JI

Abstract

INTRODUCTION

Biomarkers have emerged as interesting predictors of risk in non-ST elevation acute coronary syndromes (non-ST ACS). The aim of this study was to define the utility of the combined measurement of troponin T (TnT), C-reactive protein (CRP), NT pro-brain natriuretic peptide (NT pro-BNP) and D-dimer as biomarkers to predict adverse events.

METHODS

We included 358 consecutive patients admitted in two hospitals for non-ST ACS. Baseline measurements of TnT (associated with myocardial injury, positive, if > or =0.1 ng mL(-1)), CRP (a marker of inflammation), NT-proBNP (associated with left ventricular (dys)function) and fibrin D-dimer (and index of thrombogenesis) were performed. A positive CRP, NT-proBNP and D-dimer test was considered upper than the 75th percentile of our population. The risk for major events (death, new ACS, revascularization and heart failure) at 6 months' follow-up was analysed.

RESULTS

Troponin T, NT pro-BNP and CRP were predictors of adverse events in the multivariate analysis [hazards ratio (HR): 2.00 (1.30-3.07), P = 0.0016; HR: 2.27 (1.47-3.50), P = 0.0002; HR: 1.90 (1.24-2.92), P = 0.0034 respectively], but not D-dimer levels [HR: 1.26 (0.79-2.02), P = 0.337). After adjusting for baseline characteristics and electrocardiographic changes, multimarker risk approach was associated with adverse events at 6 months, especially with the presence of three positive biomarkers [HR 2.80 (95%CI 1.68-4.68), P < 0.001]. When we divided patients by risk groups [Thrombolysis in Myocardial Infarction (TIMI) risk score], patients with two or three elevated biomarkers had higher event rates [HR 2.59 (95% CI 1.37-4.91), P = 0.004].

CONCLUSION

A multimarker approach based on TnT, CRP and NT-proBNP provides added information to the TIMI risk score in terms of ACS prognosis at 6 months, with a worse outcome for those with two or three elevated biomarkers.

Authors+Show Affiliations

Cardiology Department, Hospital General Universitario, Alicante, Spain.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17986200

Citation

Tello-Montoliu, A, et al. "A Multimarker Risk Stratification Approach to non-ST Elevation Acute Coronary Syndrome: Implications of Troponin T, CRP, NT pro-BNP and Fibrin D-dimer Levels." Journal of Internal Medicine, vol. 262, no. 6, 2007, pp. 651-8.
Tello-Montoliu A, Marín F, Roldán V, et al. A multimarker risk stratification approach to non-ST elevation acute coronary syndrome: implications of troponin T, CRP, NT pro-BNP and fibrin D-dimer levels. J Intern Med. 2007;262(6):651-8.
Tello-Montoliu, A., Marín, F., Roldán, V., Mainar, L., López, M. T., Sogorb, F., ... Lip, G. Y. (2007). A multimarker risk stratification approach to non-ST elevation acute coronary syndrome: implications of troponin T, CRP, NT pro-BNP and fibrin D-dimer levels. Journal of Internal Medicine, 262(6), pp. 651-8.
Tello-Montoliu A, et al. A Multimarker Risk Stratification Approach to non-ST Elevation Acute Coronary Syndrome: Implications of Troponin T, CRP, NT pro-BNP and Fibrin D-dimer Levels. J Intern Med. 2007;262(6):651-8. PubMed PMID: 17986200.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A multimarker risk stratification approach to non-ST elevation acute coronary syndrome: implications of troponin T, CRP, NT pro-BNP and fibrin D-dimer levels. AU - Tello-Montoliu,A, AU - Marín,F, AU - Roldán,V, AU - Mainar,L, AU - López,M T, AU - Sogorb,F, AU - Vicente,V, AU - Lip,G Y H, Y1 - 2007/11/07/ PY - 2007/11/8/pubmed PY - 2007/12/14/medline PY - 2007/11/8/entrez SP - 651 EP - 8 JF - Journal of internal medicine JO - J. Intern. Med. VL - 262 IS - 6 N2 - INTRODUCTION: Biomarkers have emerged as interesting predictors of risk in non-ST elevation acute coronary syndromes (non-ST ACS). The aim of this study was to define the utility of the combined measurement of troponin T (TnT), C-reactive protein (CRP), NT pro-brain natriuretic peptide (NT pro-BNP) and D-dimer as biomarkers to predict adverse events. METHODS: We included 358 consecutive patients admitted in two hospitals for non-ST ACS. Baseline measurements of TnT (associated with myocardial injury, positive, if > or =0.1 ng mL(-1)), CRP (a marker of inflammation), NT-proBNP (associated with left ventricular (dys)function) and fibrin D-dimer (and index of thrombogenesis) were performed. A positive CRP, NT-proBNP and D-dimer test was considered upper than the 75th percentile of our population. The risk for major events (death, new ACS, revascularization and heart failure) at 6 months' follow-up was analysed. RESULTS: Troponin T, NT pro-BNP and CRP were predictors of adverse events in the multivariate analysis [hazards ratio (HR): 2.00 (1.30-3.07), P = 0.0016; HR: 2.27 (1.47-3.50), P = 0.0002; HR: 1.90 (1.24-2.92), P = 0.0034 respectively], but not D-dimer levels [HR: 1.26 (0.79-2.02), P = 0.337). After adjusting for baseline characteristics and electrocardiographic changes, multimarker risk approach was associated with adverse events at 6 months, especially with the presence of three positive biomarkers [HR 2.80 (95%CI 1.68-4.68), P < 0.001]. When we divided patients by risk groups [Thrombolysis in Myocardial Infarction (TIMI) risk score], patients with two or three elevated biomarkers had higher event rates [HR 2.59 (95% CI 1.37-4.91), P = 0.004]. CONCLUSION: A multimarker approach based on TnT, CRP and NT-proBNP provides added information to the TIMI risk score in terms of ACS prognosis at 6 months, with a worse outcome for those with two or three elevated biomarkers. SN - 1365-2796 UR - https://www.unboundmedicine.com/medline/citation/17986200/A_multimarker_risk_stratification_approach_to_non_ST_elevation_acute_coronary_syndrome:_implications_of_troponin_T_CRP_NT_pro_BNP_and_fibrin_D_dimer_levels_ L2 - https://doi.org/10.1111/j.1365-2796.2007.01871.x DB - PRIME DP - Unbound Medicine ER -