Reevaluation of cardiac risk scores and multiple biomarkers for the prediction of first major cardiovascular events and death in the drug-eluting stent era.
BACKGROUND
Risk scores and cardiac biomarker tests allow clinicians to accurately diagnose acute coronary syndrome (ACS) and perform early risk stratification. However, few investigations have evaluated the use of these risk scores and biomarkers for predicting risk of cardiovascular events in drug-eluting stent (DES) era.


METHODS
This prospective cohort study included 861 patients with ACS. Three risk scores-Global Registry of Acute Coronary Events (GRACEs), Platelet glycoprotein IIb/IIIa in Unstable angina: Receptor Suppression Using Integrilin, and Thrombolysis In Myocardial Infarction-and levels of four biomarkers-N-terminal pro-B-type natriuretic peptide (NT pro-BNP), high-sensitivity troponin T, heart-fatty acid binding protein, and high-sensitivity C-reactive protein-were recorded on admission. Major adverse cardiac events (MACE) (death, cardiovascular events) were evaluated at 30-day and 1-year follow-up.


RESULTS
At 30-day follow-up, there were 23 (3.1%) deaths from cardiovascular events and 4 (0.5%) cerebral accidents. NT pro-BNP levels and GRACE score were strong MACE predictors, with adjusted odds ratios (ORs) (95% CI) of 2.90 (1.63-5.20) and 1.01 (1.00-1.02), respectively, in logistic model. The C-statistic of NT pro-BNP (0.77; 95% CI, 0.67-0.86) was similar to that of GRACE score (0.76; 95% CI, 0.66-0.87); however, the combined C-statistic was higher (0.81), yielding a net reclassification improvement of 13% (p<0.01). At 1-year follow-up, there were 51 (6.8%) deaths and 10 (1.3%) cerebral accidents.


CONCLUSIONS
In the DES era, GRACE score and biomarkers can still predict major cardiac events in patients with ACS for both acute and long-term prognoses.
Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan.
Toshihito
T
Onda
Department of Cardiology, Juntendo University Nerima Hospital, Tokyo, Japan. Electronic address: inouelsbm@gmail.com.
Kenji
K
Inoue
Department of Cardiology, Juntendo University Shizuoka Hospital, Shizuoka, Japan.
Satoru
S
Suwa
Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan.
Yuji
Y
Nishizaki
Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan.
Takatoshi
T
Kasai
Department of Cardiology, Juntendo University Nerima Hospital, Tokyo, Japan.
Yuki
Y
Kimura
Department of Cardiology, Juntendo University Nerima Hospital, Tokyo, Japan.
Kentaro
K
Fukuda
Department of Cardiology, Juntendo University Nerima Hospital, Tokyo, Japan.
Iwao
I
Okai
Department of Cardiology, Juntendo University Nerima Hospital, Tokyo, Japan.
Yasumasa
Y
Fujiwara
Juntendo Clinical Research Support Center, Tokyo, Japan.
Jo
J
Matsuoka
Department of Cardiology, Juntendo University Nerima Hospital, Tokyo, Japan.
Masataka
M
Sumiyoshi
Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan.
Hiroyuki
H
Daida
D054058:Acute Coronary Syndrome / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D003643:Death; D054855:Drug-Eluting Stents / Q000009:adverse effects / Q000639:trends*; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; 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; D018570:Risk Assessment
D015415:Biomarkers; D050556:Fatty Acid-Binding Proteins; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
Acute coronary syndrome; Biomarkers; Cardiovascular risk; Percutaneous coronary intervention; Risk stratification