Prognostic Value of a Multimarker Approach for Patients Presenting to Hospital With Acute Chest Pain

• Published in: The American journal of cardiology Vol. 103; no. 1; pp. 22 - 28
• Main Authors: McCann, Conor J., MD, Glover, Ben M., MD, Menown, Ian B.A., MD, Moore, Michael J., MD, McEneny, Jane, PhD, Owens, Colum G., MD, Smith, Bernie, RGN, Sharpe, Peter C., MD, Young, Ian S., MD, Adgey, Jennifer A., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2009; Elsevier; Elsevier Limited
• Subjects: Acute Disease; Aged; Biological and medical sciences; Biomarkers - blood; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Chest Pain - blood; Chest Pain - diagnosis; Chest Pain - etiology; Electrocardiography; Fatty Acid Binding Protein 3; Fatty Acid-Binding Proteins - blood; Female; Follow-Up Studies; Heart attacks; Hospitalization; Humans; Male; Medical prognosis; Medical sciences; Middle Aged; Multivariate analysis; Myocardial Ischemia - blood; Myocardial Ischemia - complications; Myocardial Ischemia - diagnosis; Natriuretic Peptide, Brain - blood; Patient admissions; Peptide Fragments - blood; Prognosis; Prospective Studies; Protein Precursors; Proteins; Risk Factors; Human; Pain; Prognosis; Acute; Surgical approach; Thorax; Circulatory system; Hospital; Cardiology
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2008.08.026

To evaluate the prognostic role of novel biomarkers for the risk stratification of patients admitted with ischemic-type chest pain, a prospective study of 664 patients presenting to 2 coronary care units with ischemic-type chest pain was conducted over 3 years beginning in 2003. Patients were assessed on admission for clinical characteristics, electrocardiographic findings, renal function, cardiac troponin T (cTnT), markers of myocyte injury (heart fatty acid–binding protein [H-FABP] and glycogen phosphorylase BB), neurohormonal activation (N-terminal–pro-brain natriuretic peptide [NT–pro-BNP]), hemostatic activity (fibrinogen and d -dimer), and vascular inflammation (high-sensitivity C-reactive protein, myeloperoxidase, matrix metalloproteinase–9, pregnancy-associated plasma protein–A, and soluble CD40 ligand). A ≥12-hour cTnT sample was also obtained. Myocardial infarction (MI) was defined as peak cTnT ≥0.03 μg/L. Patients were followed for 1 year from the time of admission. The primary end point was death or MI. Elevated fibrinogen, d -dimer, H-FABP, NT–pro-BNP, and peak cTnT were predictive of death or MI within 1 year (unadjusted odds ratios 2.5, 3.1, 5.4, 5.4, and 6.9, respectively). On multivariate analysis, H-FABP and NT–pro-BNP were selected, in addition to age, peak cTnT, and left ventricular hypertrophy on initial electrocardiography, as significant independent predictors of death or MI within 1 year. Patients without elevations of H-FABP, NT–pro-BNP, or peak cTnT formed a very low risk group in terms of death or MI within 1 year. A very high risk group had elevations of all 3 biomarkers. In conclusion, the measurement of H-FABP and NT–pro-BNP at the time of hospital admission for patients with ischemic-type chest pain adds useful prognostic information to that provided by the measurement of baseline and 12-hour cTnT.