1. Biomarkers and Coronary Lesions Predict Outcomes after Revascularization in Non–ST-Elevation Acute Coronary Syndrome
- Author
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Lars Wallentin, Christopher P. Cannon, Maria Bertilsson, Stefan James, Evangelos Giannitsis, W. Douglas Weaver, Frederic Kontny, Robert A. Harrington, Anders Himmelmann, Philippe Gabriel Steg, Daniel Lindholm, Richard C. Becker, Robert F. Storey, Matthijs A. Velders, and Agneta Siegbahn
- Subjects
Blood Platelets ,medicine.medical_specialty ,Acute coronary syndrome ,Growth Differentiation Factor 15 ,medicine.medical_treatment ,Clinical Biochemistry ,030204 cardiovascular system & hematology ,Coronary Angiography ,Revascularization ,Risk Assessment ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Troponin T ,Predictive Value of Tests ,Internal medicine ,Natriuretic Peptide, Brain ,Myocardial Revascularization ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Acute Coronary Syndrome ,Proportional hazards model ,business.industry ,ST elevation ,Biochemistry (medical) ,Hazard ratio ,medicine.disease ,Peptide Fragments ,Treatment Outcome ,Cardiology ,Biomarker (medicine) ,business ,Biomarkers - Abstract
BACKGROUND Risk stratification in non–ST-elevation acute coronary syndrome (NSTE-ACS) is currently mainly based on clinical characteristics. With routine invasive management, angiography findings and biomarkers are available and may improve prognostication. We aimed to assess if adding biomarkers [high-sensitivity cardiac troponin T (cTnT-hs), N-terminal probrain-type natriuretic peptide (NT-proBNP), growth differentiation factor 15 (GDF-15)] and extent of coronary artery disease (CAD) might improve prognostication in revascularized patients with NSTE-ACS. METHODS In the PLATO (Platelet Inhibition and Patient Outcomes) trial, 5174 NSTE-ACS patients underwent initial angiography and revascularization and had cTnT-hs, NT-proBNP, and GDF-15 measured. Cox models were developed adding extent of CAD and biomarker levels to established clinical risk variables for the composite of cardiovascular death (CVD)/spontaneous myocardial infarction (MI), and CVD alone. Models were compared using c-statistic and net reclassification improvement (NRI). RESULTS For the composite end point and CVD, prognostication improved when adding extent of CAD, NT-proBNP, and GDF-15 to clinical variables (c-statistic 0.685 and 0.805, respectively, for full model vs 0.649 and 0.760 for clinical model). cTnT-hs did not contribute to prognostication. In the full model (clinical variables, extent of CAD, all biomarkers), hazard ratios (95% CI) per standard deviation increase were for cTnT-hs 0.93(0.81–1.05), NT-proBNP 1.32(1.13–1.53), GDF-15 1.20(1.07–1.36) for the composite end point, driven by prediction of CVD by NT-proBNP and GDF-15. For spontaneous MI, there was an association with NT-proBNP or GDF-15, but not with cTnT-hs. CONCLUSIONS In revascularized patients with NSTE-ACS, the extent of CAD and concentrations of NT-proBNP and GDF-15 independently improve prognostication of CVD/spontaneous MI and CVD alone. This information may be useful for selection of patients who might benefit from more intense and/or prolonged antithrombotic treatment. ClinicalTrials.gov Identifier: NCT00391872
- Published
- 2017
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