Biomarkers and Coronary Lesions Predict Outcomes after Revascularization in Non-ST-Elevation Acute Coronary Syndrome.

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.

• Authors: Daniel Lindholm, Stefan K James, Maria Bertilsson, Richard C Becker, Christopher P Cannon, Evangelos Giannitsis, Robert A Harrington, Anders Himmelmann, Frederic Kontny, Agneta Siegbahn, Philippe Gabriel Steg, Robert F Storey, Matthijs A Velders, W Douglas Weaver, Lars Wallentin, PLATO Investigators
• Journal: Clinical chemistry (Clin Chem) Vol. 63 Issue 2 Pg. 573-584 (Feb 2017) ISSN: 1530-8561 [Electronic] England
• PMID: 27932413 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: © 2016 American Association for Clinical Chemistry.

Chemical References

• Biomarkers
• GDF15 protein, human
• Growth Differentiation Factor 15
• Peptide Fragments
• Troponin T
• pro-brain natriuretic peptide (1-76)
• Natriuretic Peptide, Brain

Topics

• Acute Coronary Syndrome (blood, diagnosis, therapy)
• Biomarkers (blood)
• Blood Platelets (drug effects)
• Coronary Angiography
• Growth Differentiation Factor 15 (blood)
• Humans
• Myocardial Revascularization
• Natriuretic Peptide, Brain (blood)
• Peptide Fragments (blood)
• Predictive Value of Tests
• Risk Assessment
• Treatment Outcome
• Troponin T (blood)