Multimarker Risk Model Containing Troponin-T, Interleukin 10, Myeloperoxidase and Placental Growth Factor Predicts Long-Term Cardiovascular Risk After Non-ST-Segment Elevation Acute Coronary Syndrome

Study Questions:

What is the value of a biomarker panel for predicting cardiovascular (CV) outcomes following non-ST-segment elevation acute coronary syndrome (NSTE-ACS)?

Methods:

Levels of high-sensitivity C-reactive protein (hs-CRP), myeloperoxidase (MP), pregnancy-associated plasma protein A (PAPA), placental growth factor (PlGF), soluble CD40 ligand (sCD40L), interleukin-10 (IL-10), and troponin T (TnT) were determined in 1,090 patients with NSTE-ACS enrolled in the CAPTURE trial. The relationship between biomarkers and the occurrence of all-cause mortality or nonfatal myocardial infarction (MI) in the subsequent four years was studied.

Results:

The composite endpoint was reached by 15.3% of patients. Admission levels of TnT >0.01 mg/L (adjusted hazard ratio, 1.8), IL-10 <3.5 ng/L (1.7), MP >350 mg/L (1.5), and PlGF >27 ng/L (1.9) remained significant predictors for the incidence of all-cause mortality or nonfatal MI after multivariable adjustment for other biomarkers and clinical characteristics, whereas hs-CRP, PAPA, and sCD40L were only associated with the endpoint in univariate analysis. A multimarker model consisting of TnT, IL-10, MP, and PlGF predicted 4-year event rates that varied between 6.0% (all markers normal) and 35.8% (three or more biomarkers abnormal).

Conclusions:

In patients with NSTE-ACS, biomarkers reflecting the atherosclerotic process and myocardial damage of the initial cardiac event can assist in predicting long-term adverse cardiac outcomes.

Perspective:

Many individual biomarkers have been shown to be predictive of cardiovascular outcomes in patients with stable and unstable vascular disease. As new biomarkers are better characterized and assays are improved, it seems likely that multiple biomarkers reflecting distinct vascular processes may provide a more comprehensive and accurate prediction of both short- and long-term cardiovascular risk. This field will only get better and will be particularly useful when the individual biomarkers are shown to be useful in guiding specific pharmacologic interventions to reduce the vascular risk associated with the specific biomarker.

Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Dyslipidemia, Heart Failure and Cardiomyopathies, ACS and Cardiac Biomarkers, Implantable Devices, Lipid Metabolism, Heart Failure and Cardiac Biomarkers

Keywords: Interleukin-10, Myocardial Infarction, Acute Coronary Syndrome, Heart Conduction System, Ribosomal Proteins, Vascular Diseases, Troponin T, Risk Factors, Nuclear Proteins, Incidence, Prognosis, C-Reactive Protein, Biological Markers, Staphylococcal Protein A, RNA-Binding Proteins, Peroxidase, Cardiovascular Diseases, Pregnancy Proteins, Pregnancy-Associated Plasma Protein-A, Metalloproteins, CD40 Ligand


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