A comparative study of biomarkers for risk prediction in acute coronary syndrome-Results of the SIESTA (Systemic Inflammation Evaluation in non-ST-elevation Acute coronary syndrome) study.
OBJECTIVE
We compared the 1-year predictive value of several inflammatory and non-inflammatory biomarkers in ACS patients.


METHODS
In 610 patients (73.0% male)--36.0% unstable angina (UA) and 64.0% NSTEMI--we assessed high-sensitivity C-reactive protein (hs-CRP), interleukins 6, 10 and 18, soluble CD40 ligand, P- and E-selectin, NT-proBNP, fibrinogen and cystatin C at hospital admission. Two outcomes at 1-year follow up were selected for analysis: (1) all-cause death, MI, UA, or coronary revascularization, and (2) all-cause death, and non-fatal MI. The effect of biomarker levels on endpoints was examined by the Cox proportional hazards model, and their discrimination ability with the C statistic (AUC).


RESULTS
Of 549 patients (90.0%) who completed the 1-year follow up, 206 (37.5%) and 54 (8.9%) reached the first and second composite endpoints, respectively. None of the biomarkers studied improved prediction of the first endpoint. However, considered as continuous variables, and in combination, NT-proBNP and fibrinogen, increased the AUC from 0.64 (95% CI 0.55-0.72) to 0.73 (95% CI 0.64-0.81; p=0.02) for prediction of the second endpoint. Cut-off values for NT-proBNP and fibrinogen, regarding best sensitivity and specificity for prediction of the secondary endpoint were 1043.9 ng/L and 4.47 mg/dL, respectively. For these cut-off points, sensitivity, specificity, positive predictive value and negative predictive value were 40.5% vs 59.5%, 83.3% vs 67.1%, 18.8% vs 14.9% and 93.5% vs 94.4% for NT-proBNP and fibrinogen, respectively.


CONCLUSIONS
In ACS patients, inflammatory biomarkers offer modest incremental information to that provided by clinical risk markers. Fibrinogen and NT-proBNP measurements, however, improve cardiovascular risk prediction.
Kaski
Juan Carlos
JC
Cardiovascular Biology Research Centre, Division of Cardiac and Vascular Sciences, St. George's, University of London, Cranmer Terrace, London SW17 0RE, UK. j.kaski@sghms.ac.uk
Fernández-Bergés
Daniel J
DJ
Consuegra-Sánchez
Luciano
L
Fernández
José M Cruz
JM
García-Moll
Xavier
X
Mostaza
José M
JM
Cebada
Rocío Toro
RT
Juanatey
José Ramón González
JR
Martínez
Gabriela Guzmán
GG
Marrugat
Jaume
J
D054058:Acute Coronary Syndrome / Q000097:blood*; D000368:Aged; D000789:Angina, Unstable / Q000473:pathology; D019540:Area Under Curve; D015415:Biomarkers / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000378:metabolism; D005260:Female; D006801:Humans; D007249:Inflammation; D008264:Macrophages / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000378:metabolism; D020097:Natriuretic Peptide, Brain / Q000737:chemistry; D016016:Proportional Hazards Models; D017434:Protein Structure, Tertiary; D013601:T-Lymphocytes / Q000378:metabolism; D013997:Time Factors
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain