Improved risk stratification of patients with acute coronary syndromes using a combination of hsTnT, NT-proBNP and hsCRP with the GRACE score.

Klingenberg, Roland; Aghlmandi, Soheila; Räber, Lorenz; Gencer, Baris; Nanchen, David; Heg, Dik; Carballo, Sebastian; Rodondi, Nicolas; Mach, François; Windecker, Stephan; Jüni, Peter; von Eckardstein, Arnold; Matter, Christian M; Lüscher, Thomas F (2018). Improved risk stratification of patients with acute coronary syndromes using a combination of hsTnT, NT-proBNP and hsCRP with the GRACE score. European Heart Journal: Acute Cardiovascular Care, 7(2), pp. 129-138. Sage 10.1177/2048872616684678

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BACKGROUND Clinical scores and biomarkers improve risk stratification of patients with acute coronary syndromes. However, little is known about their value in patients referred for coronary angiography. METHODS Consecutive patients admitted at four Swiss university hospitals with a diagnosis of acute coronary syndrome were enrolled into the SPUM-ACS Biomarker Cohort between 2009 and 2012. Patients were followed at 30 days and 1 year with assessment of adjudicated events including all-cause mortality and the composite of all-cause mortality or non-fatal recurrent myocardial infarction. RESULTS Events and biomarkers were analysed in 1892 patients (52.4% with ST-segment elevation myocardial infarction, 43.3% with non-ST-segment elevation myocardial infarction and 4.3% with unstable angina). Death at 30 days occurred in 35 patients (1.9%) and at 1 year in 80 patients (4.3%). The choice of troponin assay (conventional versus high sensitivity) to calculate the Global Registry of Acute Coronary Events (GRACE) score did not affect risk prediction. The prognostic accuracy of the GRACE score was improved when combined with three individual biomarkers including high sensitivity troponin T (hsTnT), N-terminal-pro B-type natriuretic peptide (NT-proBNP) and high sensitivity C-reactive protein (hsCRP) to yield a 9% increment (C-statistic 0.73->0.82) for the discrimination of short-term risk for all-cause mortality. In contrast, the novel biomarkers placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1) and the ratio sFlt-1/PlGF did not improve risk stratification. CONCLUSIONS In patients with acute coronary syndrome referred for coronary angiography, combinations of biomarkers including hsTnT, NT-proBNP and hsCRP with the GRACE score enhanced risk discrimination. CLINICAL TRIALS REGISTRATION NCT01000701.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Kardiologie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Kardiologie

Graduate School:

Graduate School for Health Sciences (GHS)

UniBE Contributor:

Aghlmandi, Soheila; Räber, Lorenz; Heg, Dierik Hans; Rodondi, Nicolas and Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

2048-8734

Publisher:

Sage

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

30 Dec 2016 10:50

Last Modified:

20 Mar 2018 01:30

Publisher DOI:

10.1177/2048872616684678

PubMed ID:

28029055

Additional Information:

Klingenberg, Aghlmandi, Matter and Lüscher contributed equally to this work.

Uncontrolled Keywords:

Acute coronary syndromes; biomarkers; risk stratification

BORIS DOI:

10.7892/boris.92305

URI:

https://boris.unibe.ch/id/eprint/92305

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