Abstract
Objective
We compared the 1-year predictive value of several inflammatory and non-inflammatory
biomarkers in ACS patients.
Methods
In 610 patients (73.0% male) – 36.0% unstable angina (UA) and 64.0% NSTEMI – we assessed
high-sensitivity C-reactive protein (hs-CRP), interleukins 6, 10 and 18, soluble CD40
ligand, P- and E-selectin, NT-proBNP, fibrinogen and cystatin C at hospital admission.
Two outcomes at 1-year follow up were selected for analysis: (1) all-cause death,
MI, UA, or coronary revascularization, and (2) all-cause death, and non-fatal MI.
The effect of biomarker levels on endpoints was examined by the Cox proportional hazards
model, and their discrimination ability with the C statistic (AUC).
Results
Of 549 patients (90.0%) who completed the 1-year follow up, 206 (37.5%) and 54 (8.9%)
reached the first and second composite endpoints, respectively. None of the biomarkers
studied improved prediction of the first endpoint. However, considered as continuous
variables, and in combination, NT-proBNP and fibrinogen, increased the AUC from 0.64
(95% CI 0.55–0.72) to 0.73 (95% CI 0.64–0.81; p = 0.02) for prediction of the second endpoint. Cut-off values for NT-proBNP and fibrinogen,
regarding best sensitivity and specificity for prediction of the secondary endpoint
were 1043.9 ng/L and 4.47 mg/dL, respectively. For these cut-off points, sensitivity, specificity, positive
predictive value and negative predictive value were 40.5% vs 59.5%, 83.3% vs 67.1%,
18.8% vs 14.9% and 93.5% vs 94.4% for NT-proBNP and fibrinogen, respectively.
Conclusion
In ACS patients, inflammatory biomarkers offer modest incremental information to that
provided by clinical risk markers. Fibrinogen and NT-proBNP measurements, however,
improve cardiovascular risk prediction.
Abbreviations:
ACS (Acute coronary syndrome), AMI (Acute myocardial infarction), UA (Unstable angina), CD (Cardiac death), CAD (Coronary artery disease), PCI (Percutaneous coronary intervention), hs-CRP (High-sensitivity C-reactive protein), TIMI (Thrombolysis in Myocardial Infarction), NSTE-ACS (Non-ST-segment elevation acute coronary syndrome), NSTEMI (Non-ST-segment elevation myocardial infarction), NT-proBNP (N-terminal prohormone brain natriuretic peptide)Keywords
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Article Info
Publication History
Published online: July 12, 2010
Accepted:
June 13,
2010
Received in revised form:
June 12,
2010
Received:
December 17,
2009
Footnotes
☆This paper was presented in part at the Scientific Sessions of the American Heart Association, New Orleans, Louisiana, November 2008.
Identification
Copyright
© 2010 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
