title: Multiple biomarkers at admission are associated with angiographic, electrocardiographic, and imaging cardiovascular mechanistic markers of outcomes in patients undergoing primary percutaneous coronary intervention for acute ST-elevation myocardial infarction.
abstract: BACKGROUND
  The multimarker risk score, based on estimated glomerular filtration rate, glucose, and N-terminal probrain natriuretic peptide (NT-proBNP), has been shown to predict mortality in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). In this study, we investigated the relation between the multimarker risk score and cardiovascular mechanistic markers of outcomes in STEMI patients undergoing PPCI.
  
  
  METHODS
  Complete biomarkers were available in 197 patients with STEMI. Angiographic Thrombolysis In Myocardial Infarction flow grade and myocardial blush grade at the end of the PPCI, electrocardiographic ST-segment resolution (STR) at the time of last contrast injection and 240 minutes after last contrast, and cardiac magnetic resonance (CMR) left ventricular ejection fraction (LVEF) and infarct size at 4 to 6 months after the index event were available.
  
  
  RESULTS
  In linear regression models, higher multimarker scores were associated with worse angiographic (P < .01 for both outcomes), electrocardiographic (P < .001 for the association with STR at last contrast, and P < .01 for STR at 240 minutes), and CMR outcomes (P < .01 for both).
  
  
  CONCLUSIONS
  The multimarker risk score is associated with angiographic, electrocardiographic, and CMR mechanistic markers of outcomes. These data support the ability of the multimarker risk score to identify patients at high risk for suboptimal reperfusion and CMR outcomes and may aid in the early triage of patients who stand to benefit most of adjuvant treatments in STEMI.
authors.affiliation: Department of Cardiology, Academic Medical Center-University of Amsterdam, Academic Medical Center Meibergdreef 9, Amsterdam, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Damman
authors.forename: Wichert J
authors.initials: WJ
authors.lastname: Kuijt
authors.forename: Pier
authors.initials: P
authors.lastname: Woudstra
authors.forename: Joost D E
authors.initials: JD
authors.lastname: Haeck
authors.forename: Karel T
authors.initials: KT
authors.lastname: Koch
authors.forename: Youlan L
authors.initials: YL
authors.lastname: Gu
authors.forename: Jan P
authors.initials: JP
authors.lastname: van Straalen
authors.forename: Johan
authors.initials: J
authors.lastname: Fischer
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.forename: Mitchell W
authors.initials: MW
authors.lastname: Krucoff
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: de Winter
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000401:mortality; D056988:Anterior Wall Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D015415:Biomarkers / Q000032:analysis / Q000378:metabolism; D001786:Blood Glucose / Q000032:analysis; D015331:Cohort Studies; D016001:Confidence Intervals; D017023:Coronary Angiography / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D020097:Natriuretic Peptide, Brain / Q000032:analysis; D010343:Patient Admission; D010446:Peptide Fragments / Q000032:analysis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D013318:Stroke Volume; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain