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Aims  Biomarkers have shown promising results in risk assessment of cardiovascular events. Their role in predicting the risk of sudden cardiac death ( SCD ) is not well established. We tested the performance of several biomarkers in risk assessment for  SCD  in patients with coronary artery disease ( CAD ) and preserved left ventricular function.    Methods and results  The study population consisted of 1,946  CAD  patients (68% male; mean age 66.9±8.6 yrs; type 2 diabetes ( T2D ) 43%) enrolled in the  ARTEMIS  study. The study subjects underwent examinations with echocardiography and measurement of several biomarkers. The primary endpoint of the study was  SCD . During the mean follow up of 76±20 months 50 patients experienced SCD. Elevated high sensitive  CRP  ( hs-CRP , p = 0.001), soluble  ST2  ( sST2 , p<0.001), B-type natriuretic peptide ( BNP , p<0.001), and highly sensitive TroponinT ( hs-TnT , p<0.001) predicted the occurrence of  SCD  in univariate analysis. Using the optimal cutoff points, elevated  sST2  (≥27.45ng/mL; hazard ratio [ HR ] 2.7; 95% CI  1.4–5.1, p = 0.003) and  hs-TnT  (≥15 ng/mL;  HR  2.9; 95%  CI  1.5–5.6, p = 0.002) were the strongest predictors of  SCD  followed by  hs-CRP  ( HR  2.4; 95% CI 1.3–4.4, p = 0.004) and  BNP  ( HR  1.9; 95%  CI  1.0–3.7, p = 0.046) in adjusted analysis. Combination of elevated  hs-TnT  and  sST2  resulted in adjusted  HR  of 6.4 (95%  CI  2.6–15.5, p<0.001).    Conclusion  Elevated  sST2  and  hs-TnT  predict the occurrence of  SCD  among patients with  CAD  and preserved left ventricular function. The association between  sST2 ,  hs-TnT  and  SCD  may be explained by an ongoing myocardial apoptosis followed by fibrosis leading to vulnerability to malignant arrhythmias.

Biomarkers as predictors of sudden cardiac death in coronary artery disease patients with preserved left ventricular function (ARTEMIS study)