title: Risk stratification of ischaemic patients with implantable cardioverter defibrillators by C-reactive protein and a multi-markers strategy: results of the CAMI-GUIDE study.
abstract: OBJECTIVE
  Patients at risk of sudden cardiac death (SCD) after myocardial infarction (MI) can be offered therapy with implantable cardioverter defibrillators (ICDs). Whether plasma biomarkers can help risk stratify for SCD and ventricular arrhythmias (VT/VF) is unclear.
  
  
  RESULTS
  The primary objective of the CAMI-GUIDE study is to assess the predictive role of C-reactive protein for SCD or VT/VF in ischaemic patients with the ejection fraction <30% and ICDs. Secondary endpoints included all-cause mortality, hospitalizations, and death from heart failure. Additional analyses incorporated cystatin-C and NT-ProBNP in multi-marker approach for the prediction of adverse outcomes. A total of 300 patients were enrolled. All-cause mortality at 2 years was 22.6%, mortality from heart failure was 8.3%. Primary endpoint occurred in 17.3%. At a competing risk multivariable analysis adjusted for baseline variables, no significant difference in primary endpoint was found between patients with C-reactive protein ≤3 vs. >3 mg/L [heart rate (HR) 0.91 (0.50-1.64) P = 0.76], while C-reactive protein >3 mg/L was strongly associated with mortality due to heart failure [HR: 3.17 (1.54-6.54) P = 0.002]. NT-proBNP above median was significantly associated with the primary endpoint [adjusted HR: 1.46 (1.020-2.129) P = 0.042]. A risk function, including the three biomarkers, NYHA class and resting HR, allowed stratification of patient mortality risk from 5 to 50%.
  
  
  CONCLUSIONS
  C-reactive protein >3 mg/L is not associated with SCD or fast VT/VF, however, is a strong predictor of HF mortality. Biomarkers combined with clinical markers allow an excellent risk stratification of mortality at 2 years.
authors.affiliation: Division of Cardiology, Policlinico A. Gemelli, Catholic University of the Sacred Heart, Largo Gemelli 8, Rome, Italy. lmbiasucci@virgilio.it
authors.forename: Luigi M
authors.initials: LM
authors.lastname: Biasucci
authors.forename: Fulvio
authors.initials: F
authors.lastname: Bellocci
authors.forename: Maurizio
authors.initials: M
authors.lastname: Landolina
authors.forename: Roberto
authors.initials: R
authors.lastname: Rordorf
authors.forename: Antonello
authors.initials: A
authors.lastname: Vado
authors.forename: Endrj
authors.initials: E
authors.lastname: Menardi
authors.forename: Giovanna
authors.initials: G
authors.lastname: Giubilato
authors.forename: Serafino
authors.initials: S
authors.lastname: Orazi
authors.forename: Massimo
authors.initials: M
authors.lastname: Sassara
authors.forename: Antonello
authors.initials: A
authors.lastname: Castro
authors.forename: Riccardo
authors.initials: R
authors.lastname: Massa
authors.forename: Antoine
authors.initials: A
authors.lastname: Kheir
authors.forename: Gabriele
authors.initials: G
authors.lastname: Zaccone
authors.forename: Catherine
authors.initials: C
authors.lastname: Klersy
authors.forename: Francesco
authors.initials: F
authors.lastname: Accardi
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism*; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality; D017180:Tachycardia, Ventricular / Q000097:blood / Q000401:mortality / Q000628:therapy*
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein