title: Multimarker risk model containing troponin-T, interleukin 10, myeloperoxidase and placental growth factor predicts long-term cardiovascular risk after non-ST-segment elevation acute coronary syndrome.
abstract: OBJECTIVE
  To evaluate the predictive value of seven biomarkers, which individually have been shown to be independent predictors, for use in a combined multimarker model for long-term cardiovascular outcome after non-ST-segment elevation acute coronary syndrome (NSTEACS).
  
  
  METHODS
  Levels of high-sensitivity C-reactive protein (hsCRP), myeloperoxidase, pregnancy-associated plasma protein A, placental growth factor (PlGF), soluble CD40 ligand (sCD40L), interleukin 10 (IL-10) and troponin-T (TnT) were determined in patients enrolled in the CAPTURE trial. Cox proportional hazard regression analyses were applied to evaluate the relation between biomarkers and the occurrence of all-cause mortality or non-fatal myocardial infarction (MI).
  
  
  METHODS
  1090 patients with NSTEACS.
  
  
  METHODS
  All-cause mortality and non-fatal MI during a median follow-up of 4 years.
  
  
  RESULTS
  The composite endpoint was reached by 15.3% of patients. Admission levels of TnT >0.01 μg/l (adjusted HR 1.8), IL-10 <3.5 ng/l (1.7), myeloperoxidase >350 μg/l (1.5) and PlGF >27 ng/l (1.9) remained significant predictors for the incidence of all-cause mortality or non-fatal MI after multivariable adjustment for other biomarkers and clinical characteristics, whereas hsCRP, pregnancy-associated plasma protein A and sCD40L were only associated with the endpoint in univariate analysis. A multimarker model consisting of TnT, IL-10, myeloperoxidase and PlGF predicted 4-year event rates that varied between 6.0% (all markers normal) and 35.8% (three or more biomarkers abnormal).
  
  
  CONCLUSIONS
  In patients with NSTEACS, biomarkers characterising distinct aspects of the underlying atherosclerotic process and myocardial damage of the initial cardiac event can assist in predicting long-term adverse cardiac outcomes. The use of combinations of selected biomarkers adds incremental predictive value to further risk stratification in an otherwise seemingly homogeneous NSTEACS population.
authors.affiliation: Thoraxcenter, Department of Cardiology, ErasmusMC and Cardiovascular Research Institute COEUR, Rotterdam, The Netherlands.
authors.forename: R M
authors.initials: RM
authors.lastname: Oemrawsingh
authors.forename: T
authors.initials: T
authors.lastname: Lenderink
authors.forename: K M
authors.initials: KM
authors.lastname: Akkerhuis
authors.forename: C
authors.initials: C
authors.lastname: Heeschen
authors.forename: S
authors.initials: S
authors.lastname: Baldus
authors.forename: S
authors.initials: S
authors.lastname: Fichtlscherer
authors.forename: C W
authors.initials: CW
authors.lastname: Hamm
authors.forename: M L
authors.initials: ML
authors.lastname: Simoons
authors.forename: E
authors.initials: E
authors.lastname: Boersma
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D004562:Electrocardiography; D004812:Epidemiologic Methods; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D016753:Interleukin-10 / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D009195:Peroxidase / Q000097:blood; D000072483:Placenta Growth Factor; D011257:Pregnancy Proteins / Q000097:blood; D011379:Prognosis; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; C000608036:PGF protein, human; D011257:Pregnancy Proteins; D020107:Troponin T; D016753:Interleukin-10; D000072483:Placenta Growth Factor; D009195:Peroxidase