Open AccessBiomarker of Collagen Turnover (C‐Terminal Telopeptide) and Prognosis in Patients With Non‐ ST ‐Elevation Acute Coronary Syndromes
Author(s) -
Zelniker Thomas A.,
Jarolim Petr,
Scirica Benjamin M.,
Braunwald Eugene,
Park JeongGun,
Das Saumya,
Sabatine Marc S.,
Morrow David A.
Publication year - 2019
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.118.011444
Subject(s) - medicine , hazard ratio , cardiology , quartile , acute coronary syndrome , natriuretic peptide , heart failure , biomarker , proportional hazards model , troponin t , troponin , brain natriuretic peptide , confidence interval , myocardial infarction , biochemistry , chemistry
Background Small studies have suggested an association between markers of collagen turnover and adverse outcomes in heart failure ( HF ). We examined C‐terminal telopeptide (beta‐ CT x) and the risk of cardiovascular death or new or worsening HF in non– ST ‐elevation acute coronary syndrome. Methods and Results We measured baseline serum beta‐ CT x, NT ‐pro BNP (N‐terminal pro‐B‐type natriuretic peptide), hsTnT (high‐sensitivity cardiac troponin T) and hs CRP (high‐sensitivity C‐reactive protein) (Roche Diagnostics) in a nested biomarker analysis (n=4094) from a study of patients with non– ST ‐elevation acute coronary syndrome. The relationship between quartiles of beta‐ CT x and cardiovascular death or HF over a median follow‐up time of 12 months was analyzed using adjusted Cox models. Higher beta‐ CT x levels identified a significantly higher risk of cardiovascular death/ HF (Q4 10.9% versus Q1 3.8%, Logrank P <0.001). After multivariable adjustment, beta‐ CT x in the top quartile (Q4) was associated with cardiovascular death/ HF (Q4 versus Q1: adjusted hazard ratio 2.22 [1.50–3.27]) and its components (Q4 versus Q1: cardiovascular death: adjusted hazard ratio 2.48 [1.46–4.21]; HF : adjusted hazard ratio 2.04 [1.26–3.30]). In an adjusted multimarker model including NT ‐pro BNP , hsTnT, and hs CRP , beta‐ CT x remained independently associated with cardiovascular death/ HF (Q4 versus Q1: adjusted hazard ratio 1.98 [1.34–2.93]) and its components. Beta‐ CT x correlated weakly with NT ‐pro BNP ( r =0.17, P <0.001) and left ventricular ejection fraction ( r =−0.05, P =0.008) and did not correlate with hsTnT ( r =0.02, P =0.20), or hs CRP ( r =−0.03, P =0.09). Conclusions Levels of beta‐ CT x, a biomarker of collagen turnover, were associated with cardiovascular death and HF in patients with non– ST ‐elevation acute coronary syndrome. This biomarker, which correlated only weakly or not significantly with traditional biomarkers of cardiovascular death and HF , may provide complementary pathobiological insight and risk stratification in these patients.