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Prognostic value of biomarkers during and after non-ST-segment elevation acute coronary syndrome.
J Am Coll Cardiol 2009; 54(4):357-64JACC

Abstract

OBJECTIVES

The aim of this study was to assess risk prediction by different biomarkers in patients with an ongoing non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and after clinical stabilization.

BACKGROUND

Different biomarkers reflect different aspects of the pathobiology in NSTE-ACS. However, there is little information regarding their relative prognostic value during the time course of disease.

METHODS

The N-terminal pro-brain natriuretic peptide (NT-proBNP), C-reactive protein (CRP), cardiac troponin I (cTnI), and the estimated glomerular filtration rate (eGFR) were measured at randomization and after 6 weeks and 6 months in 877 NSTE-ACS patients included in the FRISC (FRagmin and fast revascularization during InStability in Coronary artery disease) II trial. The biomarkers' prognostic value during 5-year follow-up was evaluated by Cox regression models, calculation of the c-statistics, and estimation of the net reclassification improvement (NRI).

RESULTS

Among the biomarkers measured at randomization, NT-proBNP was the strongest predictor for mortality (adjusted hazard ratio [HR]: 1.7; 95% confidence interval [CI]: 1.3 to 2.1; p < 0.001). Even during follow-up, NT-proBNP demonstrated the strongest association to the composite end point of death/myocardial infarction (adjusted HR at 6 weeks: 1.5; 95% CI: 1.3 to 1.7; p < 0.001; adjusted HR at 6 months: 1.4; 95% CI: 1.2 to 1.7; p = 0.001). Even CRP was independently predictive at 6 months for the composite end point (adjusted HR: 1.3; 95% CI: 1.1 to 1.5; p = 0.003). Only 6-week results of NT-proBNP provided significant incremental prognostic value to established risk indicators regarding the composite end point (c-statistics 0.69 [p = 0.03]; NRI 0.11 [p = 0.03]).

CONCLUSIONS

The NT-proBNP is an independent risk predictor in patients with ongoing NSTE-ACS and after clinical stabilization. The CRP exhibits increasing predictive value at later measurements. However, only NT-proBNP provided incremental prognostic value and might therefore be considered as a complement for early follow-up controls after NSTE-ACS.

Authors+Show Affiliations

Department of Medical Sciences, Cardiology, Uppsala University Hospital and Uppsala Clinical Research Centre, Uppsala, Sweden. kai.eggers@ucr.uu.seNo 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

19608034

Citation

Eggers, Kai M., et al. "Prognostic Value of Biomarkers During and After non-ST-segment Elevation Acute Coronary Syndrome." Journal of the American College of Cardiology, vol. 54, no. 4, 2009, pp. 357-64.
Eggers KM, Lagerqvist B, Venge P, et al. Prognostic value of biomarkers during and after non-ST-segment elevation acute coronary syndrome. J Am Coll Cardiol. 2009;54(4):357-64.
Eggers, K. M., Lagerqvist, B., Venge, P., Wallentin, L., & Lindahl, B. (2009). Prognostic value of biomarkers during and after non-ST-segment elevation acute coronary syndrome. Journal of the American College of Cardiology, 54(4), pp. 357-64. doi:10.1016/j.jacc.2009.03.056.
Eggers KM, et al. Prognostic Value of Biomarkers During and After non-ST-segment Elevation Acute Coronary Syndrome. J Am Coll Cardiol. 2009 Jul 21;54(4):357-64. PubMed PMID: 19608034.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic value of biomarkers during and after non-ST-segment elevation acute coronary syndrome. AU - Eggers,Kai M, AU - Lagerqvist,Bo, AU - Venge,Per, AU - Wallentin,Lars, AU - Lindahl,Bertil, PY - 2008/10/20/received PY - 2009/01/30/revised PY - 2009/03/10/accepted PY - 2009/7/18/entrez PY - 2009/7/18/pubmed PY - 2009/9/1/medline SP - 357 EP - 64 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 54 IS - 4 N2 - OBJECTIVES: The aim of this study was to assess risk prediction by different biomarkers in patients with an ongoing non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and after clinical stabilization. BACKGROUND: Different biomarkers reflect different aspects of the pathobiology in NSTE-ACS. However, there is little information regarding their relative prognostic value during the time course of disease. METHODS: The N-terminal pro-brain natriuretic peptide (NT-proBNP), C-reactive protein (CRP), cardiac troponin I (cTnI), and the estimated glomerular filtration rate (eGFR) were measured at randomization and after 6 weeks and 6 months in 877 NSTE-ACS patients included in the FRISC (FRagmin and fast revascularization during InStability in Coronary artery disease) II trial. The biomarkers' prognostic value during 5-year follow-up was evaluated by Cox regression models, calculation of the c-statistics, and estimation of the net reclassification improvement (NRI). RESULTS: Among the biomarkers measured at randomization, NT-proBNP was the strongest predictor for mortality (adjusted hazard ratio [HR]: 1.7; 95% confidence interval [CI]: 1.3 to 2.1; p < 0.001). Even during follow-up, NT-proBNP demonstrated the strongest association to the composite end point of death/myocardial infarction (adjusted HR at 6 weeks: 1.5; 95% CI: 1.3 to 1.7; p < 0.001; adjusted HR at 6 months: 1.4; 95% CI: 1.2 to 1.7; p = 0.001). Even CRP was independently predictive at 6 months for the composite end point (adjusted HR: 1.3; 95% CI: 1.1 to 1.5; p = 0.003). Only 6-week results of NT-proBNP provided significant incremental prognostic value to established risk indicators regarding the composite end point (c-statistics 0.69 [p = 0.03]; NRI 0.11 [p = 0.03]). CONCLUSIONS: The NT-proBNP is an independent risk predictor in patients with ongoing NSTE-ACS and after clinical stabilization. The CRP exhibits increasing predictive value at later measurements. However, only NT-proBNP provided incremental prognostic value and might therefore be considered as a complement for early follow-up controls after NSTE-ACS. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/19608034/Prognostic_value_of_biomarkers_during_and_after_non_ST_segment_elevation_acute_coronary_syndrome_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)01445-4 DB - PRIME DP - Unbound Medicine ER -