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Biomarkers improved prediction of mortality in patients with STEMI undergoing primary PCI
Damman P. J Am Coll Cardiol. 2011;57:29-36.
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The addition of a multimarker to a model that included established risk factors benefited the prediction of mortality in patients with STEMI who were undergoing primary percutaneous coronary intervention.
“This is one of the first studies to evaluate a multimarker approach for the prediction of baseline risk of long-term death in patients undergoing primary PCI for STEMI,” the researchers wrote. “Incorporation of … three predictive biomarkers in the multimarker risk score yields important information regarding baseline risk and mortality.”
The study included 1,034 patients with STEMI undergoing primary PCI from an intervention center in the Netherlands between Jan. 1, 2005, and Jan. 1, 2007. Researchers tested whether combining N-terminal pro-brain natriuretic peptide, CRP, glucose, cardiac troponin T and estimated glomerular filtration rate improved mortality prediction.
During a mean follow-up of 901 days, 120 patients died. Statistically significant predictors of mortality included glucose, N-terminal pro-brain natriuretic peptide and estimated glomerular filtration rate.
According to researchers, a risk score that incorporated these three biomarkers identified a high-risk STEMI subgroup with a higher mortality vs. an intermediate- or low-risk subgroup (P<.001). Additionally, the three biomarkers, when added to established prognostic factors, improved mortality prediction, which was indicated by the net reclassification improvement (P<.001) and integrated discrimination improvement (P<.01).
“The study provides important pathophysiological information confirming the common roots of ACS, either ST segment elevation or non-ST elevation, and promising clinical improvements in STEMI treatment,” Luigi M. Biasucci, MD, and Roberta Della Bona, MD,both with the department of cardiology, Catholic University of the Sacred Heart, Rome, wrote in an accompanying editorial. “Although their efforts fell short of the objectives, we hope that they will contribute to a more accurate and individualized prognostication and therapy, with consequent reduction in events and the flourishing of novel pathophysiological information.”
Disclosures: Dr. Biasucci is a consultant for Sanofi-Aventis, Bristol-Myers Squibb, Pfizer and Siemens Diagnostics, and has received lecture fees from Sanofi-Aventis, Bristol-Myers Squibb, Merck and Siemens Diagnostics and research grants from Sanofi-Aventis, Bristol-Myers Squibb and Boehringer Ingelheim. Dr. Della Bona reports no relevant financial disclosures.
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