Abstract 16198: Evaluation of Multiple Biomarkers of Cardiomyocyte Stress or Injury to Predict Cardiovascular Death or CHF in STEMI: Findings from CLARITY-TIMI 28
Background: Markers of cardiomyocyte stress including atrial naturetic peptide (ANP), adrenomedullin (ADM), and copeptin help predict mortality in heart failure (HF). Little is known about the utility of these markers or their prohormones for predicting CV death (CVD) or HF in ST-elevation myocardial infarction (STEMI).
Methods: Circulating midregional (MR)-proANP, MR-proADM, and copeptin levels were measured (BRAHMS GmbH) at presentation in 1120 STEMI patients undergoing fibrinolysis in CLARITY-TIMI 28. Patients were stratified into quartiles by baseline biomarker level and multivariable logistic regression was used to examine the association between each marker and CVD/HF at 30 days. In a model adjusted for clinical factors, forward selection was used to evaluate the 3 novel biomarkers as well as 3 previously examined biomarkers: NT-proBNP, ST2, and cardiac troponin.
Results: Baseline levels of MR-proANP, MR-proADM, and copeptin tended to be higher in patients who were older, female, had a h/o HF, were treated later after sx onset, had an anterior MI, and were in Killip class II-IV. For each biomarker, in unadjusted analyses, patients in the top quartile were at significantly increased risk of CVD/HF (p≤0.013 for each). After adjusting for baseline characteristics, MR-proANP remained an independent predictor of CVD/HF (OR 2.07 [1.20-3.57], p=0.009, Q4 vs Q1-3). In a multimarker model adjusted for clinical factors, MR-proANP (which rendered NT-proBNP non-significant), ST2, and cTnT each remained significant predictors of CVD/HF (Figure). The addition of these biomarkers resulted in a c-statistic of 0.865, led to significant net reclassification improvement (0.589, p<0.001) and integrated discrimination improvement (0.049, p<0.001).
Conclusion: In patients with STEMI, circulating levels of biomarkers of cardiomyocyte stress or injury measured at presentation add to traditional clinical factors in predicting the risk of CV death or heart failure.
- © 2011 by American Heart Association, Inc.