title: Multimarker risk strategy for predicting 1-month and 1-year major events in non-ST-elevation acute coronary syndromes.
abstract: BACKGROUND
  The aim of this study was to define the utility of the combined measurement of troponin I, myoglobin, C-reactive protein, fibrinogen, and homocysteine to predict risk in non-ST elevation acute coronary syndromes.
  
  
  METHODS
  Troponin I, myoglobin, high-sensitivity C-reactive protein, fibrinogen, and homocysteine were measured in 557 consecutive patients admitted to our institution for non-ST elevation acute coronary syndrome. The risk for major events (death or nonfatal myocardial infarction) at first month and at first year follow-up was analyzed.
  
  
  RESULTS
  In a multivariate model adjusting for baseline characteristics and electrocardiographic changes, the only biomarkers related to major events at first month were C-reactive protein (P = .007) and myoglobin (P = .02), and at first year troponin I (P = .02), C-reactive protein (P = .03), and homocysteine (P = .04). The rate of major events depending on the number (0-5) of elevated biomarkers were at first month: 4.1%, 3.7%, 5.7%, 6.1%, 6.5%, and 30.8% (P < .0001), and at first year: 8.2%, 11.1%, 12.3%, 16.2%, 23.7%, and 50% (P < .0001). A simple score including the number of elevated biomarkers showed an adjusted risk of major events of 1.6 [1.3-1.9] at first month and of 1.4 [1.2-1.7] at first year.
  
  
  CONCLUSIONS
  Markers of myocardial damage, inflammation, and homocysteine analyzed separately provide prognostic information. The number of elevated biomarkers is an independent risk predictor of major events.
authors.affiliation: Servei de Cardiología, Hospital Clínic i Universitari, Universitat de València, València, Spain. vicentbodi@hotmail.com
authors.forename: Vicent
authors.initials: V
authors.lastname: Bodí
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
authors.forename: Angel
authors.initials: A
authors.lastname: Llàcer
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Fácila
authors.forename: Julio
authors.initials: J
authors.lastname: Núñez
authors.forename: Mauricio
authors.initials: M
authors.lastname: Pellicer
authors.forename: Vicente
authors.initials: V
authors.lastname: Bertomeu
authors.forename: Vicente
authors.initials: V
authors.lastname: Ruiz
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Chorro
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D000789:Angina, Unstable / Q000097:blood*; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis; D004562:Electrocardiography; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D005500:Follow-Up Studies; D006710:Homocysteine / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood*; D017202:Myocardial Ischemia / Q000401:mortality; D009211:Myoglobin / Q000097:blood; D011379:Prognosis; D012008:Recurrence; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D019210:Troponin I / Q000097:blood
chemical_list: D015415:Biomarkers; D009211:Myoglobin; D019210:Troponin I; D006710:Homocysteine; D005340:Fibrinogen; D002097:C-Reactive Protein