title: 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.
abstract: 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.
authors.affiliation: 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
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Kaski
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Fernández-Bergés
authors.forename: Luciano
authors.initials: L
authors.lastname: Consuegra-Sánchez
authors.forename: José M Cruz
authors.initials: JM
authors.lastname: Fernández
authors.forename: Xavier
authors.initials: X
authors.lastname: García-Moll
authors.forename: José M
authors.initials: JM
authors.lastname: Mostaza
authors.forename: Rocío Toro
authors.initials: RT
authors.lastname: Cebada
authors.forename: José Ramón González
authors.initials: JR
authors.lastname: Juanatey
authors.forename: Gabriela Guzmán
authors.initials: GG
authors.lastname: Martínez
authors.forename: Jaume
authors.initials: J
authors.lastname: Marrugat
mesh_terms: 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
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain