Abstract 2063: Diagnostic Value of Multimarker Testing including Myeloperoxidase in Patients with Acute Coronary Syndrome Results from a Multicentre Biomarker Study
Background The early diagnosis of Acute Coronary Syndrome (ACS) is still a diagnostic challenge. The aim of the present study was to determine the power of an index of biomarkers to aid in the diagnosis of ACS.
Methods In a multicenter cohort of 1382 patients with ACS including unstable angina (n=504), NSTEMI (n=482) and STEMI (n=396) patients the power of a weighed panel index consisting of the biomarkers myeloperoxidase (MPO), troponin I, creatine kinase MB, and B-type natriuretic peptide (BNP), was assessed for differential diagnosis of ACS from non-cardiac chest pain patients (NCCP; n=513) and healthy controls (HC; n=203) and compared to the power of any single marker additionally including myoglobin.
Results The panel index was superior, as judged by area under the receiver operated characteristics (ROC) curve, relative to single marker determination at all times measured after chest pain onset (0 – 48h). Within the first hours (0 –3h) the index revealed an AUC of 0.94 (against HC) and 0.81 (against NCCP) for the diagnosis of ACS (NSTEMI and UAP). Similar results were observed for UAP patients alone 0 –3h with an AUC of 0.97 (against HC) and 0.84 (against NCCP). These results are consistent for all times after chest pain onset. Of the single markers, levels of MPO peaked earliest after chest pain onset compared to myoglobin, CK-MB, TNI, and BNP. Within 0 –3 hours of chest pain onset, MPO revealed the highest AUC compared to any single marker determined for the identification of UAP alone (0.92 against HC; 0.77 against NCCP) or both, UAP and NSTEMI (0.88 against HC; 0.71 against NCCP). In the prospective analyses, BNP was the strongest risk predictor: one standard deviation increase in BNP was associated with a 1.53 (1.37–1.70) increase in hazard risk for long term mortality (2.5 years). Data will be presented on the performance of the panel index relative to single markers with respect to long term mortality.
Conclusion A multimarker approach is more sensitive than a single marker for the diagnosis of ACS. In particular, inclusion of MPO adds value for early diagnosis.