Abstract 17350: Multimarker Risk Stratification in Patients with Acute Myocardial Infarction
Background: Circulating biomarkers have been evaluated largely individually for risk stratification in the setting of acute myocardial infarction (MI). The optimal multimarker strategy remains undefined.
Methods: A total of 11 established and emerging biomarkers representing different pathobiological axes were studied. Specifically, MR-proADM, MR-proANP, copeptin, hsCRP, galectin-3, GDF-15, MPO, NT-proBNP, ST-2, PAPP-A and troponin T (TnT) were measured at presentation in 1258 patients from CLARITY-TIMI 28, a randomized trial of clopidogrel in ST-elevation MI (STEMI). Patients were followed for 30 days. Biomarker analyses were adjusted for age, sex, comorbidities, heart rate, blood pressure, creatinine clearance, Killip class, lytic type and timing, anterior MI and treatment arm. Forward stepwise selection was used to assess a multimarker strategy.
Results: When examined individually (Figure, left), 7 biomarkers were each associated with an increased risk of CV death or heart failure through 30 days independent of standard clinical factors. In a multimarker model, 3 biomarkers emerged as independent and complementary predictors of CV death or HF: TnT, ST2, and MPO (Figure, right). A multimarker risk score significantly improved the C-statistic for predicting CV death or HF as compared with the TIMI STEMI Risk Score alone (AUC 0.75 to 0.82, P=0.001) as well as the NRI and IDI (P<0.01 for each).
Conclusions: In patients with STEMI, a multimarker strategy that combines biomarkers across pathobiological axes of cardiomyocyte necrosis, hemodynamic stress and inflammation provides incremental prognostic information for risk stratification.
Author Disclosures: M.L. O’Donoghue: Research Grant; Significant; AstraZeneca, GlaxoSmithKline, Eisai. Honoraria; Modest; diaDexus. D.A. Morrow: Research Grant; Significant; Amgen, AstraZeneca, Beckman Coulter, BG Medicine, BRAHMS, Bristol-Myers Squibb, Critical Diagnostics, CV Therapeutics, Daiichi Sankyo Co Ltd, Eli Lilly and Co, GlaxoSmithKline, Johnson & Johnson, Merck and Co, Novartis Pharmaceuticals, Roche Diagnostics, Sanofi-Aventis, Singulex, and Takeda.. Consultant/Advisory Board; Modest; Abbott Laboratories, DiaDexus, Eli Lilly, Gilead, Instrumentation Laboratory, Konica Minolta, Johnson & Johnson, Merck, Roche Diagnostics, and Servier. N. Desai: None. M. Sherwood: None. S.A. Murphy: None. C.P. Cannon: Research Grant; Significant; Accumetrics Arisaph* AstraZeneca* Boehringer-Ingelheim* CSL Behring Essentialis GlaxoSmithKline* Janssen* Merck* Regeneron Sanofi Takeda. Consultant/Advisory Board; Modest; Bristol-Myers Squibb Lipimedix* Pfizer. R.E. Gerszten: None. M.S. Sabatine: Research Grant; Significant; Abbott Laboratories; Amgen; AstraZeneca; AstraZeneca / Bristol-Myers Squibb Alliance; Critical Diagnostics; Daiichi-Sankyo; Eisai; Genzyme; GlaxoSmithKline; Intarcia; Merck; Roche Diagnostics, Sanofi-aventis; Takeda. Consultant/Advisory Board; Modest; Amgen; AstraZeneca; Bristol-Myers Squibb; Intarcia; MyoKardia; Pfizer; Sanofi-aventis; Zeus.
- © 2014 by American Heart Association, Inc.