We sought to assess whether multiple
biomarkers would correlate with the outcome and could improve event prediction in non-ST-segment elevation
acute coronary syndrome populations with low event rates. Nine inflammatory, ischemic, or neurohormonal
biomarkers were measured within 48 hours after symptom onset in 440 patients with non-ST-segment elevation
acute coronary syndrome from the ARCHIPELAGO (
Irbesartan in Patients With
Acute Coronary Syndrome Without ST Segment Elevation) trial. We assessed the relation between
biomarkers and ischemic or
heart failure composite end points at 2 months of follow-up. We also evaluated whether
biomarkers could improve the predictive performance of the validated and well-performing Global Registry of Acute Coronary Events risk score. Among all
biomarkers measured at baseline, only
interleukin-6 correlated with the ischemic end point (adjusted odds ratio 1.69, 95% confidence interval [CI] 1.23 to 2.31). The independent correlates of the
heart failure end point were
B-type natriuretic peptide (adjusted odds ratio 3.16, 95% CI 1.99 to 5.03),
aldosterone (adjusted odds ratio 1.57, 95% CI 1.14 to 2.16) and
matrix metalloproteinase-9 (adjusted odds ratio 0.64, 95% CI 0.46 to 0.88). The Global Registry of Acute Coronary Events score predicted poorly the ischemic end point (area under the curve [AUC] 0.591) and fairly (AUC 0.775) the
heart failure end point. The performance of the models was significantly improved by the introduction of
interleukin-6 (AUC 0.685) for the ischemic end point and of the 3
biomarkers (AUC 0.874) for the
heart failure end point. In conclusion, the
interleukin-6 level only, and
B-type natriuretic peptide,
aldosterone, and
matrix metalloproteinase-9 together, independently correlated with the ischemic and
heart failure end points, respectively. The Global Registry of Acute Coronary Events risk score's performance was significantly improved with a
biomarker strategy. In low-risk populations, a strategy using these
biomarkers might help in identifying patients at greater risk of additional events.