title: Multimarker approach with cystatin C, N-terminal pro-brain natriuretic peptide, C-reactive protein and red blood cell distribution width in risk stratification of patients with acute coronary syndromes.
abstract: OBJECTIVE
  Biomarkers have emerged as interesting predictors of risk in patients with acute coronary syndromes (ACS). The aim of this study was to determine the utility of the combined measurement of cystatin C (CysC), C-reactive protein (CRP), N-terminal pro-brain natriuretic peptide (NT-proBNP) and red blood cell distribution width (RDW) in the risk stratification of patients with ACS.
  
  
  METHODS
  In this prospective study including 682 patients consecutively admitted to a coronary care unit for ACS, baseline measurements of CysC, CRP, NT-proBNP and RDW were performed. Patients were categorized on the basis of the number of elevated biomarkers at presentation. The primary outcome was 6-month mortality.
  
  
  RESULTS
  The number of biomarkers elevated on admission (study score) was an independent predictor of 6-month mortality; patients with four biomarkers elevated on admission had a significantly higher risk of 6-month mortality compared with patients with none or one. In addition, in patients with high risk defined by the GRACE score, our multimarker score was able to further categorize their risk of 6-month mortality.
  
  
  CONCLUSIONS
  A multimarker approach using CysC, NT-proBNP, CRP and RDW was an independent predictor of 6-month mortality and added prognostic information to the GRACE risk score in patients with ACS and high risk defined by GRACE, with increasing mortality in patients with a higher number of elevated biomarkers on admission.
authors.affiliation: Department of Cardiology of Hospital de Braga, Braga, Portugal. Electronic address: katarinafvieira@gmail.com.
authors.forename: Catarina
authors.initials: C
authors.lastname: Vieira
authors.affiliation: Department of Cardiology of Hospital de Braga, Braga, Portugal.
authors.forename: Sérgio
authors.initials: S
authors.lastname: Nabais
authors.affiliation: Department of Cardiology of Hospital de Braga, Braga, Portugal.
authors.forename: Vítor
authors.initials: V
authors.lastname: Ramos
authors.affiliation: Department of Cardiology of Hospital de Braga, Braga, Portugal.
authors.forename: Carlos
authors.initials: C
authors.lastname: Braga
authors.affiliation: Department of Cardiology of Hospital de Braga, Braga, Portugal.
authors.forename: António
authors.initials: A
authors.lastname: Gaspar
authors.affiliation: Department of Cardiology of Hospital de Braga, Braga, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Azevedo
authors.affiliation: Department of Cardiology of Hospital de Braga, Braga, Portugal.
authors.forename: Miguel
authors.initials: M
authors.lastname: Álvares Pereira
authors.affiliation: Department of Cardiology of Hospital de Braga, Braga, Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Salomé
authors.affiliation: Department of Cardiology of Hospital de Braga, Braga, Portugal.
authors.forename: Adelino
authors.initials: A
authors.lastname: Correia
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000401:mortality; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D055316:Cystatin C / Q000097:blood*; D004909:Erythrocyte Indices; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012306:Risk; D013997:Time Factors
chemical_list: D015415:Biomarkers; D055316:Cystatin C; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein
keywords: Acute coronary syndromes; C-reactive protein; Cistatina C; Cystatin C; Estratificação multimarcadores; Multimarker stratification; N-terminal pro-brain natriuretic peptide; Pro-peptídeo natriurético tipo B; Proteína C reativa; Síndromes coronárias agudas