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A multimarker risk stratification approach to non‐ST elevation acute coronary syndrome: implications of troponin T, CRP, NT pro‐BNP and fibrin D‐dimer levels
Author(s) -
TelloMontoliu A.,
Marín F.,
Roldán V.,
Mainar L.,
López M. T.,
Sogorb F.,
Vicente V.,
Lip G. Y. H.
Publication year - 2007
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1111/j.1365-2796.2007.01871.x
Subject(s) - medicine , troponin t , d dimer , cardiology , acute coronary syndrome , natriuretic peptide , troponin , c reactive protein , heart failure , population , brain natriuretic peptide , myocardial infarction , inflammation , environmental health
. Tello‐Montoliu A, Marín F, Roldán V, Mainar L, López MT, Sogorb F, Vicente V, Lip GYH (Hospital General Universitario, Alicante; Hospital Morales Meseguer, Murcia; Hospital de Requena, Valencia; Hospital General Universitario, Alicante, Spain and City Hospital, Birmingham, UK). A multimarker risk stratification approach to non‐ST elevation acute coronary syndrome: implications of troponin T, CRP, NT pro‐BNP and fibrin D‐dimer levels. J Intern Med 2007; 262 : 651–658. Introduction. Biomarkers have emerged as interesting predictors of risk in non‐ST elevation acute coronary syndromes (non‐ST ACS). The aim of this study was to define the utility of the combined measurement of troponin T (TnT), C‐reactive protein (CRP), NT pro‐brain natriuretic peptide (NT pro‐BNP) and D‐dimer as biomarkers to predict adverse events. Methods. We included 358 consecutive patients admitted in two hospitals for non‐ST ACS. Baseline measurements of TnT (associated with myocardial injury, positive, if ≥0.1ng mL −1 ), CRP (a marker of inflammation), NT‐proBNP (associated with left ventricular (dys)function) and fibrin D‐dimer (and index of thrombogenesis) were performed. A positive CRP, NT‐proBNP and D‐dimer test was considered upper than the 75th percentile of our population. The risk for major events (death, new ACS, revascularization and heart failure) at 6 months’ follow‐up was analysed. Results. Troponin T, NT pro‐BNP and CRP were predictors of adverse events in the multivariate analysis [hazards ratio (HR): 2.00 (1.30–3.07), P = 0.0016; HR: 2.27 (1.47–3.50), P = 0.0002; HR: 1.90 (1.24–2.92), P = 0.0034 respectively], but not D‐dimer levels [HR: 1.26 (0.79–2.02), P = 0.337). After adjusting for baseline characteristics and electrocardiographic changes, multimarker risk approach was associated with adverse events at 6 months, especially with the presence of three positive biomarkers [HR 2.80 (95%CI 1.68–4.68), P < 0.001]. When we divided patients by risk groups [Thrombolysis in Myocardial Infarction (TIMI) risk score], patients with two or three elevated biomarkers had higher event rates [HR 2.59 (95% CI 1.37–4.91), P = 0.004]. Conclusion. A multimarker approach based on TnT, CRP and NT‐proBNP provides added information to the TIMI risk score in terms of ACS prognosis at 6 months, with a worse outcome for those with two or three elevated biomarkers.