Abstract 16326: A Multi-Marker Approach for the Prediction of Adverse Events in Patients with Acute Myocardial Infarction
Background: Cardiac troponin I (cTnI), high sensitivity C-reactive protein (hsCRP), serum creatinine (sCr) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) have emerged as strong predictors of adverse events (AE). Each has a different diagnostic and prognostic attributes. Therefore, a combination of markers may be able to stratify acute myocardial infarction (AMI) patients. Our aim is to evaluate the prognostic performance of each of markers, individually, and in combination for prediction of AE in AMI patients, especially, in the era of high performance of echocardiography and primary percutaneous coronary intervention.
Methods: Of total 16264 AMI patients enrolled in KORMI (Korean Registry of AMI), 3654 patients, who performed baseline measurements of hsCRP, sCr, NT-proBNP and peak TnI, were included. AE defined as composite endpoints of death, MI and target vessel revascularization (TVR) through 12 months were recorded.
Results: Mean age was 65.2±12.5 years, 70.4% were men. Initial vital sign was 127/78 mmHg with heart rate 78 beat/minute. Mean left ventricular ejection fraction was 52.5±11.8%. Early period AEs occurred in 9.7% including in-hospital death, 6.6% and long-term event at 12 months occurred in 13.3% including death 10.4%. In a multivariable model that included each biomarker, hsCRP (Hazard Ratio [HR] 2.47, 95% confidence interval [CI] 1.979-3.089), NT-proBNP (HR 3.60, 95%CI 2.685-4.832) and sCr (HR 5.49, 95%CI 4.195-7.164) were independent predictors of AE at 30 days. In predictors of the composite endpoint at 12 months, hsCRP (HR 2.30, 95% CI 1.896-2.791), NT-proBNP (HR 3.00, 95%CI 2.363-3.809), sCr (HR 6.24, 95%CI 4.878-7.988) were independent risk factors. When we divided patients by number of biomarkers, patients with two and three elevated biomarkers had higher AE at 30 days (HR 3.32, 95%CI 1.808-6.099; and HR 11.13, 95%CI 5.755-21.535) and 12 months (HR 3.15, 95%CI 1.872-5.292; and HR 12.50, 95%CI 7.000-22.326).
Conclusion: Biomarkers reflecting myonecrosis (TnI), inflammation (CRP), renal injury (sCR) and myocardial stretch (NT-proBNP) provide complementary prognostic information in AMI. When used together, these novel markers may provide superior risk stratification over a long-term major cardiac event.
- © 2012 by American Heart Association, Inc.