title: Usefulness of cardiac biomarker score for risk stratification in stable patients undergoing elective cardiac evaluation across glycemic status.
abstract: Several clinically available cardiac biomarkers have established their prognostic value in patients with acute coronary syndromes. However, their relative prognostic significance in stable subjects has not been prospectively validated, either individually or in combination. The aim of this study was to evaluate the extent to which B-type natriuretic peptide, myeloperoxidase, and high-sensitivity C-reactive protein alone or together could be prognostic biomarkers in 3,635 consecutive stable patients without acute coronary syndrome who underwent elective diagnostic coronary angiography. After adjusting for traditional risk factors and renal function, each of the markers monitored was a significant predictor of incident major adverse cardiovascular events (death, nonfatal myocardial infarction, and stroke) over 3 years. A cardiac biomarker score based on the sum total of "positive" biomarkers provided independent prediction of future risk for incident major adverse cardiovascular events at 3 years (hazard ratio [HR] 7.61, 95% confidence interval [CI] 4.98 to 11.65, p <0.001), even after adjusted for traditional risk factors (HR 6.11, 95% CI 3.98 to 9.38, p <0.001). A positive cardiac biomarker score remained a strong and independent predictor of 3-year risk for major adverse cardiovascular events among those with normal glycemic control (HR 4.24, 95% CI 1.96 to 9.18, p <0.001), those with prediabetes (HR 7.62, 95% CI 3.87 to 15.01, p <0.001), and those with diabetes (HR 5.61, 95% CI 2.55 to 12.33, p <0.001), as well as within subjects without significant angiographic evidence of coronary artery disease (HR 10.82, 95% CI 3.82 to 30.6, p <0.001). In conclusion, an integrated assessment of cardiac biomarkers may provide independent prognostic value for long-term adverse clinical events in stable cardiac patients.
authors.affiliation: Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA. tangw@ccf.org
authors.forename: W H Wilson
authors.initials: WH
authors.lastname: Tang
authors.forename: Naveed
authors.initials: N
authors.lastname: Iqbal
authors.forename: Yuping
authors.initials: Y
authors.lastname: Wu
authors.forename: Stanley L
authors.initials: SL
authors.lastname: Hazen
mesh_terms: D015415:Biomarkers / Q000097:blood*; D001786:Blood Glucose / Q000378:metabolism*; D002097:C-Reactive Protein / Q000378:metabolism; D002423:Cause of Death / Q000639:trends; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000097:blood / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009820:Ohio / Q000453:epidemiology; D009195:Peroxidase / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D015996:Survival Rate / Q000639:trends; D019210:Troponin I / Q000097:blood
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D019210:Troponin I; D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein; D009195:Peroxidase