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Computationally generated biomarkers predicted CV deaths

Syed Z. Sci Transl Med. 2011;doi:10.1126/scitranslmed.3002557.

Issue: November 2011

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Using computationally generated biomarkers after non–ST-elevation acute coronary syndrome increases prediction of deaths by echocardiography by 50% and improves precision, researchers reported in a recent study.

The researchers examined available electrocardiogram data from 4,557 patients hospitalized with non–ST-elevation ACS enrolled in the MERLIN-TIMI-36 clinical trial. They used morphologic variability, symbolic mismatch and heart rate motifs — three computationally generated cardiac biomarkers — to investigate for risk stratification. The three biomarkers were then compared with thrombolysis in MI risk score, left ventricular ejection fraction, heart rate variability, heart rate turbulence, deceleration capacity, severe autonomic failure and T-wave alternans.

Patients were followed for a median of 348 days, and those with median- to high-risk clinical features were enrolled within 48 hours of their last ischemic symptoms, receiving standard medical and interventional therapy, according to researchers.

Overall, researchers found a strong association among morphologic variability (HR=3.20; 95% CI, 2.07-4.95), symbolic mismatch (HR=2.06; 95% CI, 1.28-3.34), and heart rate motifs (HR=2.71; 95% CI, 1.75-4.19) and CV death in patients in the LVEF 40% or more population after ACS, with one-half of patients diagnosed with non-STEMI and three-quarters at moderate or high risk according to TIMI risk score. There was a strong association with CV death after non–ST-elevation ACS and the biomarkers, with the association being strongest for morphologic variability (HR=3.31; 95% CI, 2.49-4.40), then symbolic mismatch (HR=2.36; 95% CI, 1.73-3.22) and, finally, heart rate motifs (HR=2.21; 95% CI, 1.65-2.97).

There were low correlations between the biomarkers and TIMI risk score (P=.059-.101) and LVEF (P=.055-.139), according to study results. During the follow-up period and after adjustment for TIMI risk score, LVEF and other ECG-based metrics, morphologic variability (HR=1.67; 95% CI, 1.02-2.73), symbolic mismatch (HR=1.94; 95% CI, 1.27-2.98), and heart rate motifs (HR=2.14; 95% CI, 1.40-2.36) were associated with CV death.

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