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Clinical correlation of multiple biomarkers for risk assessment in patients with acute coronary syndrome.
Indian Heart J 2008 Nov-Dec; 60(6):536-42IH

Abstract

OBJECTIVE

Biochemical markers are useful for the prediction of future cardiovascular events in patients with non-ST-segment elevation acute coronary syndrome (ACS). The independent as well as the combined prognostic value of elevated troponin-T, high-sensitivity C-reactive protein (hs-CRP), and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) on the Thrombolysis In Myocardial Infarction (TIMI) risk score and on the short-term prognosis were evaluated in a cohort of ACS patients.

METHODS AND RESULTS

In an unselected, heterogeneous group of 80 patients with ACS (i.e., unstable angina [USA] or non-ST-elevation myocardial infarction [NSTEMI]), the levels of troponin-T, hs-CRP, and NT-pro-BNP were analyzed. The correlation between elevation of different biomarkers with TIMI risk score and their impact on 30-day major adverse cardiac events was sought. The levels of hs-CRP were significantly higher in patients who had angina as their predominant complaint (3.67 mg/dl vs. 1.67 mg/dl: p < 0.01), while levels of NT-pro-BNP was higher in those patients who had any element of heart failure at presentation (2616.39 pg/ml vs. 1068.3 pg/ml; p < 0.01). Troponin-T was highest in patients who had an element of both heart failure and angina at presentation (p < 0.01). The TIMI risk score expectedly had a positive and strong correlation with elevated troponin-T, but had no correlation with elevation of hs-CRP and NT-pro-BNP in isolation. However, when any two biomarkers were elevated, the patients were in the intermediate risk group as per TIMI risk score irrespective of troponin-T-elevation. When all the three biomarkers were elevated, the risk equaled the high-risk category of TIMI risk score. Elevated hs-CRP (3.40 mg/dl vs. 1.38 mg/dl; p < 0.001) and troponin-T (2.37 ng/ml vs. 1.23 ng/ml; p < 0.001) at baseline correlated independently with the occurrence of re-ischemia, while elevated NT-pro-BNP alone correlated significantly with the development of heart failure within 30 days of follow-up (4247.76 pg/ml vs. 1210.86 pg/ml; p < 0.01). The highest risk of death from any cardiovascular cause within 30 days of follow-up was significantly higher when all the three biomarkers were elevated.

CONCLUSION

The use of NT-pro-BNP, hs-CRP, and troponin-T in combination appears to add critical prognostic insight to the assessment of patients with ACS.

Authors+Show Affiliations

Department of Cardiology, King George Medical University, Lucknow.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19276492

Citation

Narain, V S., et al. "Clinical Correlation of Multiple Biomarkers for Risk Assessment in Patients With Acute Coronary Syndrome." Indian Heart Journal, vol. 60, no. 6, 2008, pp. 536-42.
Narain VS, Gupta N, Sethi R, et al. Clinical correlation of multiple biomarkers for risk assessment in patients with acute coronary syndrome. Indian Heart J. 2008;60(6):536-42.
Narain, V. S., Gupta, N., Sethi, R., Puri, A., Dwivedi, S. K., Saran, R. K., & Puri, V. K. (2008). Clinical correlation of multiple biomarkers for risk assessment in patients with acute coronary syndrome. Indian Heart Journal, 60(6), pp. 536-42.
Narain VS, et al. Clinical Correlation of Multiple Biomarkers for Risk Assessment in Patients With Acute Coronary Syndrome. Indian Heart J. 2008;60(6):536-42. PubMed PMID: 19276492.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical correlation of multiple biomarkers for risk assessment in patients with acute coronary syndrome. AU - Narain,V S, AU - Gupta,Nishant, AU - Sethi,Rishi, AU - Puri,Aniket, AU - Dwivedi,S K, AU - Saran,R K, AU - Puri,V K, PY - 2009/3/12/entrez PY - 2009/3/12/pubmed PY - 2009/4/11/medline SP - 536 EP - 42 JF - Indian heart journal JO - Indian Heart J VL - 60 IS - 6 N2 - OBJECTIVE: Biochemical markers are useful for the prediction of future cardiovascular events in patients with non-ST-segment elevation acute coronary syndrome (ACS). The independent as well as the combined prognostic value of elevated troponin-T, high-sensitivity C-reactive protein (hs-CRP), and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) on the Thrombolysis In Myocardial Infarction (TIMI) risk score and on the short-term prognosis were evaluated in a cohort of ACS patients. METHODS AND RESULTS: In an unselected, heterogeneous group of 80 patients with ACS (i.e., unstable angina [USA] or non-ST-elevation myocardial infarction [NSTEMI]), the levels of troponin-T, hs-CRP, and NT-pro-BNP were analyzed. The correlation between elevation of different biomarkers with TIMI risk score and their impact on 30-day major adverse cardiac events was sought. The levels of hs-CRP were significantly higher in patients who had angina as their predominant complaint (3.67 mg/dl vs. 1.67 mg/dl: p < 0.01), while levels of NT-pro-BNP was higher in those patients who had any element of heart failure at presentation (2616.39 pg/ml vs. 1068.3 pg/ml; p < 0.01). Troponin-T was highest in patients who had an element of both heart failure and angina at presentation (p < 0.01). The TIMI risk score expectedly had a positive and strong correlation with elevated troponin-T, but had no correlation with elevation of hs-CRP and NT-pro-BNP in isolation. However, when any two biomarkers were elevated, the patients were in the intermediate risk group as per TIMI risk score irrespective of troponin-T-elevation. When all the three biomarkers were elevated, the risk equaled the high-risk category of TIMI risk score. Elevated hs-CRP (3.40 mg/dl vs. 1.38 mg/dl; p < 0.001) and troponin-T (2.37 ng/ml vs. 1.23 ng/ml; p < 0.001) at baseline correlated independently with the occurrence of re-ischemia, while elevated NT-pro-BNP alone correlated significantly with the development of heart failure within 30 days of follow-up (4247.76 pg/ml vs. 1210.86 pg/ml; p < 0.01). The highest risk of death from any cardiovascular cause within 30 days of follow-up was significantly higher when all the three biomarkers were elevated. CONCLUSION: The use of NT-pro-BNP, hs-CRP, and troponin-T in combination appears to add critical prognostic insight to the assessment of patients with ACS. SN - 0019-4832 UR - https://www.unboundmedicine.com/medline/citation/19276492/Clinical_correlation_of_multiple_biomarkers_for_risk_assessment_in_patients_with_acute_coronary_syndrome_ DB - PRIME DP - Unbound Medicine ER -