Multimarker Risk Stratification in Patients With Acute Myocardial Infarction
BackgroundSeveral biomarkers have individually been shown to be useful for risk stratification in patients with acute myocardial infarction (MI). The optimal multimarker strategy remains undefined. Methods and ResultsBiomarkers representing different pathobiological axes were studied, including myoc...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2016-05-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.115.002586 |
| _version_ | 1828948312477138944 |
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| author | Michelle L. O'Donoghue David A. Morrow Christopher P. Cannon Petr Jarolim Nihar R. Desai Matthew W. Sherwood Sabina A. Murphy Robert E. Gerszten Marc S. Sabatine |
| author_facet | Michelle L. O'Donoghue David A. Morrow Christopher P. Cannon Petr Jarolim Nihar R. Desai Matthew W. Sherwood Sabina A. Murphy Robert E. Gerszten Marc S. Sabatine |
| author_sort | Michelle L. O'Donoghue |
| collection | DOAJ |
| description | BackgroundSeveral biomarkers have individually been shown to be useful for risk stratification in patients with acute myocardial infarction (MI). The optimal multimarker strategy remains undefined. Methods and ResultsBiomarkers representing different pathobiological axes were studied, including myocardial stress/structural changes (NT‐pro B‐type natriuretic peptide [NT‐proBNP], midregional proatrial natriuretic peptide [MR‐proANP], suppression of tumorigenicity 2 [ST2], galectin‐3, midregional proadrenomedullin [MR‐proADM], and copeptin), myonecrosis (troponin T), and inflammation (myeloperoxidase [MPO], high sensitivity C‐reactive protein [hsCRP], pregnancy‐associated plasma protein A [PAPP‐A], and growth‐differentiation factor‐15 [GDF‐15]), in up to 1258 patients from Clopidogrel as Adjunctive Reperfusion Therapy‐Thrombolysis in Myocardial Infarction 28 (CLARITY‐TIMI 28), a randomized trial of clopidogrel in ST‐elevation MI (STEMI). Patients were followed for 30 days. Biomarker analyses were adjusted for traditional clinical variables. Forward step‐wise selection was used to assess a multimarker strategy. After adjustment for clinical variables and using a dichotomous cutpoint, 7 biomarkers were each significantly associated with a higher odds of cardiovascular death or heart failure (HF) through 30 days, including NT‐proBNP (adjusted odds ratio [ORadj], 2.54; 95% CI, 1.47–4.37), MR‐proANP (2.18; 1.27–3.76), ST2 (2.88; 1.72–4.81), troponin T (4.13; 1.85–9.20), MPO (2.75; 1.20–6.27), hsCRP (1.96, 1.17–3.30), and PAPP‐A (3.04; 1.17–7.88). In a multimarker model, 3 biomarkers emerged as significant and complementary predictors of cardiovascular death or HF: ST2 (ORadj, 2.87; 1.61–5.12), troponin T (2.34; 1.09–5.01 and 4.13, 1.85–9.20, respectively for intermediate and high levels), and MPO (2.49; 1.04–5.96). When added to the TIMI STEMI Risk Score alone, the multimarker risk score significantly improved the C‐statistic (area under the curve, 0.75 [95% CI, 0.69–0.81] to 0.82 [0.78–0.87]; P=0.001), net reclassification index (0.93; P<0.001), and integrated discrimination index (0.09; P<0.001). ConclusionsIn patients with STEMI, a multimarker strategy that combines biomarkers across pathobiological axes of myocardial stress, myocyte necrosis, and inflammation provides incremental prognostic information for prediction of cardiovascular death or HF. |
| first_indexed | 2024-12-14T05:45:38Z |
| format | Article |
| id | doaj.art-3ca4736ea2f5447fbcb39dd0544e0fe9 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-14T05:45:38Z |
| publishDate | 2016-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-3ca4736ea2f5447fbcb39dd0544e0fe92022-12-21T23:14:53ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802016-05-015510.1161/JAHA.115.002586Multimarker Risk Stratification in Patients With Acute Myocardial InfarctionMichelle L. O'Donoghue0David A. Morrow1Christopher P. Cannon2Petr Jarolim3Nihar R. Desai4Matthew W. Sherwood5Sabina A. Murphy6Robert E. Gerszten7Marc S. Sabatine8TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, MATIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, MATIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, MACardiovascular Division, Brigham and Women's Hospital, Boston, MACenter for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, CTDivision of Cardiovascular Medicine, Duke University Medical Center, Duke Clinical Research Institute, Durham, NCTIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, MACardiolovascular Division, Beth Israel Deaconess Medical Center, Boston, MATIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, MABackgroundSeveral biomarkers have individually been shown to be useful for risk stratification in patients with acute myocardial infarction (MI). The optimal multimarker strategy remains undefined. Methods and ResultsBiomarkers representing different pathobiological axes were studied, including myocardial stress/structural changes (NT‐pro B‐type natriuretic peptide [NT‐proBNP], midregional proatrial natriuretic peptide [MR‐proANP], suppression of tumorigenicity 2 [ST2], galectin‐3, midregional proadrenomedullin [MR‐proADM], and copeptin), myonecrosis (troponin T), and inflammation (myeloperoxidase [MPO], high sensitivity C‐reactive protein [hsCRP], pregnancy‐associated plasma protein A [PAPP‐A], and growth‐differentiation factor‐15 [GDF‐15]), in up to 1258 patients from Clopidogrel as Adjunctive Reperfusion Therapy‐Thrombolysis in Myocardial Infarction 28 (CLARITY‐TIMI 28), a randomized trial of clopidogrel in ST‐elevation MI (STEMI). Patients were followed for 30 days. Biomarker analyses were adjusted for traditional clinical variables. Forward step‐wise selection was used to assess a multimarker strategy. After adjustment for clinical variables and using a dichotomous cutpoint, 7 biomarkers were each significantly associated with a higher odds of cardiovascular death or heart failure (HF) through 30 days, including NT‐proBNP (adjusted odds ratio [ORadj], 2.54; 95% CI, 1.47–4.37), MR‐proANP (2.18; 1.27–3.76), ST2 (2.88; 1.72–4.81), troponin T (4.13; 1.85–9.20), MPO (2.75; 1.20–6.27), hsCRP (1.96, 1.17–3.30), and PAPP‐A (3.04; 1.17–7.88). In a multimarker model, 3 biomarkers emerged as significant and complementary predictors of cardiovascular death or HF: ST2 (ORadj, 2.87; 1.61–5.12), troponin T (2.34; 1.09–5.01 and 4.13, 1.85–9.20, respectively for intermediate and high levels), and MPO (2.49; 1.04–5.96). When added to the TIMI STEMI Risk Score alone, the multimarker risk score significantly improved the C‐statistic (area under the curve, 0.75 [95% CI, 0.69–0.81] to 0.82 [0.78–0.87]; P=0.001), net reclassification index (0.93; P<0.001), and integrated discrimination index (0.09; P<0.001). ConclusionsIn patients with STEMI, a multimarker strategy that combines biomarkers across pathobiological axes of myocardial stress, myocyte necrosis, and inflammation provides incremental prognostic information for prediction of cardiovascular death or HF.https://www.ahajournals.org/doi/10.1161/JAHA.115.002586biomarkersmultimarkerprognosisST‐elevation myocardial infarctionThrombolysis in Myocardial Infarction risk score |
| spellingShingle | Michelle L. O'Donoghue David A. Morrow Christopher P. Cannon Petr Jarolim Nihar R. Desai Matthew W. Sherwood Sabina A. Murphy Robert E. Gerszten Marc S. Sabatine Multimarker Risk Stratification in Patients With Acute Myocardial Infarction Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease biomarkers multimarker prognosis ST‐elevation myocardial infarction Thrombolysis in Myocardial Infarction risk score |
| title | Multimarker Risk Stratification in Patients With Acute Myocardial Infarction |
| title_full | Multimarker Risk Stratification in Patients With Acute Myocardial Infarction |
| title_fullStr | Multimarker Risk Stratification in Patients With Acute Myocardial Infarction |
| title_full_unstemmed | Multimarker Risk Stratification in Patients With Acute Myocardial Infarction |
| title_short | Multimarker Risk Stratification in Patients With Acute Myocardial Infarction |
| title_sort | multimarker risk stratification in patients with acute myocardial infarction |
| topic | biomarkers multimarker prognosis ST‐elevation myocardial infarction Thrombolysis in Myocardial Infarction risk score |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.115.002586 |
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