The long-term prognostic value of multiple biomarkers following a myocardial infarction.
BACKGROUND
We assessed the long-term prognostic value of multiple cardiac biomarkers after an acute myocardial infarction (MI) in order to evaluate a multimarker approach to risk stratification.


METHODS
Blood samples from 298 patients hospitalized with a myocardial infarction were subsequently tested for NT-proBNP, hsCRP, MMP-9, PAPP-A, MPO, sCD40L and FM.


RESULTS
During the median follow-up period of 45 months, 83 patients suffered at least one TnT- positive event. In the unadjusted analysis NT-proBNP predicted future ACS or cardiac death with a hazard ratio (HR) of 1.83 (95% confidence interval (CI), 1.17-2.87, p=0.009) in Q4 as compared to the three lower quartiles (Q1-3). However, NT-proBNP was dependent on chronic heart failure and HDL-cholesterol in the stepwise multivariable model, with a hazard ratio (HR) in Q4 of 1.38 (95% CI, 0.82-2.33, p=0.229). The other biomarkers were not found to be related to the primary event following the index MI.


CONCLUSIONS
In a patient population consisting of 298 subjects hospitalized with a MI, a multimarker approach with NT-proBNP, hsCRP, MMP-9, PAPP-A, MPO, sCD40L and FM rendered no additional prognostic information beyond conventionally used stratification tools in the acute phase. However, this does not preclude clinical valuable prognostic information by a biomarker such as NT-proBNP.
Brügger-Andersen
Trygve
T
Institute of Medicine, University of Bergen, Stavanger University Hospital, Stavanger, Norway. hagerman@online.no
Aarsetøy
Hildegunn
H
Grundt
Heidi
H
Staines
Harry
H
Nilsen
Dennis W T
DW
D000328:Adult; D000368:Aged; D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis; D023201:CD40 Ligand / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D008297:Male; D020780:Matrix Metalloproteinase 9 / Q000097:blood; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D009195:Peroxidase / Q000097:blood; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis; D011379:Prognosis; D011446:Prospective Studies
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D010446:Peptide Fragments; C011468:fibrinmonomer; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D023201:CD40 Ligand; D002097:C-Reactive Protein; D009195:Peroxidase; D011266:Pregnancy-Associated Plasma Protein-A; D020780:Matrix Metalloproteinase 9