Abstract 2065: Multiple Biomarker Utilization for Detection of Adverse Events in Patients Presenting With Symptoms Suggestive of Acute Coronary Syndrome: Influence of eGFR
OBJECTIVES: Biomarkers have been shown to be independent predictors of short and long term risk. This study investigated multiple biomarkers representative of numerous pathophysiology pathways to determine overall patient risk of adverse outcomes in patients presenting with symptoms suggestive of ACS.
METHODS: Seven biomarkers (myeloperoxidase (MPO), soluble CD40 ligand (CD40L), placental growth factor (PIGF), metalloproteinase-9 (MMP-9), high sensitive C-reactive protein (hsCRP), cardiac troponin I (cTnI), N-terminal pro-B-type natriuretic peptide (NT-proBNP) were measured on admission plasma specimens in 457 patients presenting with symptoms suggestive of ACS. Combined cardiac event and all cause death outcomes during 4 months of follow-up based on normal reference limits were estimated by the Kaplan-Meier method with the log rank statistic.
RESULTS: Patients with an increased level of PlGF, NT-proBNP, hsCRP, or cTnI, or a decreased eGFR had higher event rates compared to patients with normal levels. Cumulative 4 month event rates varied from 13.6% for increased cTnI to 14.8% for NT-proBNP to 17.5% for highest CRP to 21.0% for decreased eGFR. The group of 149 patients with normal NT-proBNP had the lowest cumulative endpoint rate of 0.8%. No difference in combined endpoint rate was observed for increased versus normal levels of MPO, CD40L, or MMP-9. Relative risks of events associated with an increased level of PlGF, NT-proBNP, hsCRP, cTnI or decreased eGFR ranged from 2.1 to 11.
CONCLUSION: Our findings suggest multiple biomarkers independently characterize different pathophysiologic mechanisms predictive of increased risk for adverse events.