Multimarker risk strategy for predicting 1-month and 1-year major events in non-ST-elevation acute coronary syndromes.
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.
Bodí
Vicent
V
Servei de Cardiología, Hospital Clínic i Universitari, Universitat de València, València, Spain. vicentbodi@hotmail.com
Sanchis
Juan
J
Llàcer
Angel
A
Fácila
Lorenzo
L
Núñez
Julio
J
Pellicer
Mauricio
M
Bertomeu
Vicente
V
Ruiz
Vicente
V
Chorro
Francisco J
FJ
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
D015415:Biomarkers; D009211:Myoglobin; D019210:Troponin I; D006710:Homocysteine; D005340:Fibrinogen; D002097:C-Reactive Protein