Risk Assessment after ST-Segment Elevation Myocardial Infarction: Can Biomarkers Improve the Performance of Clinical Variables?
Por:
Garcia-Osuna, A, Sans-Rosello, J, Ferrero-Gregori, A, Alquezar-Arbe, A, Sionis, A, Ordonez-Llanos, J
Publicada:
1 mar 2022
Resumen:
Introduction: Myocardial infarction with ST-segment elevation (STEMI) is the coronary artery disease associated with the highest risk of morbimortality; however, this risk is heterogeneous, usually being evaluated by clinical scores. Risk assessment is a key factor in personalized clinical management of patients with this disease. Aim: The aim of this study was to assess whether some new cardiac biomarkers considered alone, combined in a multibiomarker model or in association with clinical variables, improve the short- and long-term risk stratification of STEMI patients. Materials and Methods: This was a retrospective observational study of 253 patients with STEMI. Blood samples were obtained before or during the angiography. The assessed biomarkers were C-terminal fragment of insulin-like growth factor binding protein-4 (CT-IGFBP4), high sensitive cardiac troponin T (hs-cTnT), N-terminal fragment of probrain natriuretic peptide (NT-proBNP), and growth differentiation factor 15 (GDF-15); they reflect different cardiovascular (CV) physiopathological pathways and underlying pathologies. We registered in-hospital and follow-up mortalities and their causes (cardiovascular and all-cause) and major adverse cardiac events (MACE) during a two year follow-up. Discrimination, survival analysis, model calibration, and reclassification of the biomarkers were comprehensively evaluated. Results and Discussion: In total, 55 patients (21.7%) died, 33 in-hospital and 22 during the follow-up, most of them (69.1%) from CV causes; 37 MACE occurred during follow-up. Biomarkers showed good prognostic ability to predict mortality, alone and combined with the multibiomarker model. A predictive clinical model based on age, Killip-Kimball class, estimated glomerular filtration rate (eGFR), and heart rate was derived by multivariate analysis. GDF-15 and NT-proBNP significantly improved risk assessment of the clinical model, as shown by discrimination, calibration, and reclassification of all the end-points except for all-cause mortality. The combination of NT-proBNP and hs-cTnT improved CV mortality prediction. Conclusions: GDF-15 and NT-proBNP added value to the usual risk assessment of STEMI patients.
Filiaciones:
Garcia-Osuna, A:
Hosp Santa Creu & Sant Pau, Dept Clin Biochem, Barcelona 08041, Spain
Autonomous Univ Barcelona, Dept Clin Biochem, Barcelona 08193, Spain
Sans-Rosello, J:
Hosp Santa Creu & Sant Pau, Dept Cardiol, Barcelona 08041, Spain
Ferrero-Gregori, A:
Hosp Santa Creu & Sant Pau, Dept Cardiol, Barcelona 08041, Spain
Alquezar-Arbe, A:
Autonomous Univ Barcelona, Dept Clin Biochem, Barcelona 08193, Spain
Hosp Santa Creu & Sant Pau, Dept Emergency, Barcelona 08041, Spain
Sionis, A:
Autonomous Univ Barcelona, Dept Clin Biochem, Barcelona 08193, Spain
Hosp Santa Creu & Sant Pau, Dept Cardiol, Barcelona 08041, Spain
Ordonez-Llanos, J:
Hosp Santa Creu & Sant Pau, Dept Clin Biochem, Barcelona 08041, Spain
gold, Green Published
|