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Prognostic Value of Biomarkers During and After Non–ST-Segment Elevation Acute Coronary Syndrome
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| 07.08.2009, 22:40 |
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Objectives The aim of this study was to assess risk prediction by different biomarkers in patients with an ongoing non–STsegment
elevation acute coronary syndrome (NSTE-ACS) and after clinical stabilization.
Background Different biomarkers reflect different aspects of the pathobiology in NSTE-ACS. However, there is little information
regarding their relative prognostic value during the time course of disease.
Methods The N-terminal pro-brain natriuretic peptide (NT-proBNP), C-reactive protein (CRP), cardiac troponin I (cTnI), and the
estimated glomerular filtration rate (eGFR) were measured at randomization and after 6 weeks and 6 months in 877
NSTE-ACS patients included in the FRISC (FRagmin and fast revascularization during InStability in Coronary artery disease)
II trial. The biomarkers’ prognostic value during 5-year follow-up was evaluated by Cox regression models, calculation
of the c-statistics, and estimation of the net reclassification improvement (NRI).
Results Among the biomarkers measured at randomization, NT-proBNP was the strongest predictor for mortality (adjusted
hazard ratio [HR]: 1.7; 95% confidence interval [CI]: 1.3 to 2.1; p 0.001). Even during follow-up, NTproBNP
demonstrated the strongest association to the composite end point of death/myocardial infarction (adjusted
HR at 6 weeks: 1.5; 95% CI: 1.3 to 1.7; p 0.001; adjusted HR at 6 months: 1.4; 95% CI: 1.2 to 1.7; p
0.001). Even CRP was independently predictive at 6 months for the composite end point (adjusted HR: 1.3; 95%
CI: 1.1 to 1.5; p 0.003). Only 6-week results of NT-proBNP provided significant incremental prognostic value to
established risk indicators regarding the composite end point (c-statistics 0.69 [p 0.03]; NRI 0.11 [p 0.03]).
Conclusions The NT-proBNP is an independent risk predictor in patients with ongoing NSTE-ACS and after clinical stabilization. The
CRP exhibits increasing predictive value at later measurements. However, only NT-proBNP provided incremental prognostic
value and might therefore be considered as a complement for early follow-up controls after NSTE-ACS. (J Am
Coll Cardiol 2009;54:357–64) © 2009 by the American College of Cardiology Foundation
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| Категория: Статьи | Добавил: nbylova
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