Objective To evaluate the predictive value of seven biomarkers, which individually have been shown to be independent predictors, for use in a combined multimarker model for long-term cardiovascular outcome after non-ST-segment elevation acute coronary syndrome (NSTEACS).
Design and Setting Levels of high-sensitivity C-reactive protein (hsCRP), myeloperoxidase, pregnancy-associated plasma protein A, placental growth factor (PlGF), soluble CD40 ligand (sCD40L), interleukin 10 (IL-10) and troponin-T (TnT) were determined in patients enrolled in the CAPTURE trial. Cox proportional hazard regression analyses were applied to evaluate the relation between biomarkers and the occurrence of all-cause mortality or non-fatal myocardial infarction (MI).
Patients 1090 patients with NSTEACS.
Main Outcome Measure All-cause mortality and non-fatal MI during a median follow-up of 4 years.
Results The composite endpoint was reached by 15.3% of patients. Admission levels of TnT >0.01 μg/l (adjusted HR 1.8), IL-10 <3.5 ng/l (1.7), myeloperoxidase >350 μg/l (1.5) and PlGF >27 ng/l (1.9) remained significant predictors for the incidence of all-cause mortality or non-fatal MI after multivariable adjustment for other biomarkers and clinical characteristics, whereas hsCRP, pregnancy-associated plasma protein A and sCD40L were only associated with the endpoint in univariate analysis. A multimarker model consisting of TnT, IL-10, myeloperoxidase and PlGF predicted 4-year event rates that varied between 6.0% (all markers normal) and 35.8% (three or more biomarkers abnormal).
Conclusion In patients with NSTEACS, biomarkers characterising distinct aspects of the underlying atherosclerotic process and myocardial damage of the initial cardiac event can assist in predicting long-term adverse cardiac outcomes. The use of combinations of selected biomarkers adds incremental predictive value to further risk stratification in an otherwise seemingly homogeneous NSTEACS population.
- Acute coronary syndrome
- multimarker risk prediction model
- risk stratification
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Funding RMO is supported by a non-commercial grant from The Netherlands Heart Foundation (NHS2007B012) and the Interuniversity Cardiology Institute Netherlands (07101), both of which have been received by EB. The funding source of the CAPTURE trial, Centocor (Leiden, The Netherlands) had no participating role in any form in the current biomarker analyses.
Competing interests None.
Ethics approval This is a biomarker analysis in samples that derive from a multicentre randomised controlled trial for which ethics committee approval was obtained at both the national and local hospital levels.
Provenance and peer review Not commissioned; externally peer reviewed.
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