Roland Klingenberg1, Soheila Aghlmandi2,3, Lorenz Räber4, Baris Gencer5, David Nanchen6, Dik Heg2,3, Sebastian Carballo7, Nicolas Rodondi8,9, François Mach5, Stephan Windecker3, Peter Jüni10, Arnold von Eckardstein11, Christian M Matter1, Thomas F Lüscher1. 1. 1 Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland. 2. 2 Institute of Social and Preventive Medicine, (ISPM) University of Bern, Switzerland. 3. 3 Department of Clinical Research, Clinical Trials Unit, ISPM, University of Bern, Switzerland. 4. 4 Department of Cardiology, Cardiovascular Center, University Hospital Bern, Switzerland. 5. 5 Department of Cardiology, Cardiovascular Center, University Hospital Geneva, Switzerland. 6. 6 Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland. 7. 7 Department of General Internal Medicine, University Hospital Geneva, Switzerland. 8. 8 Department of General Internal Medicine, University Hospital Bern, Switzerland. 9. 9 Institute of Primary Health Care (BIHAM), University of Bern, Switzerland. 10. 10 Applied Health Research Centre (AHRC), Department of Medicine, University of Toronto, Canada. 11. 11 Institute of Clinical Chemistry, University Hospital Zurich, Switzerland.
Abstract
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.
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.
Authors: Jay S Shavadia; Wendimagegn Alemayehu; Christopher deFilippi; Cynthia M Westerhout; Jasper Tromp; Christopher B Granger; Paul W Armstrong; Sean van Diepen Journal: J Thromb Thrombolysis Date: 2021-10-27 Impact factor: 2.300
Authors: Xinmin S Li; Slayman Obeid; Zeneng Wang; Benjamin J Hazen; Lin Li; Yuping Wu; Alex G Hurd; Xiaodong Gu; Alan Pratt; Bruce S Levison; Yoon-Mi Chung; Steven E Nissen; Wai Hong Wilson Tang; François Mach; Lorenz Räber; David Nanchen; Christian M Matter; Thomas F Lüscher; Stanley L Hazen Journal: Eur Heart J Date: 2019-08-21 Impact factor: 29.983
Authors: Sebastian Weichwald; Alessandro Candreva; Rebekka Burkholz; Roland Klingenberg; Lorenz Räber; Dik Heg; Robert Manka; Baris Gencer; François Mach; David Nanchen; Nicolas Rodondi; Stephan Windecker; Reijo Laaksonen; Stanley L Hazen; Arnold von Eckardstein; Frank Ruschitzka; Thomas F Lüscher; Joachim M Buhmann; Christian M Matter Journal: Eur Heart J Acute Cardiovasc Care Date: 2021-10-27
Authors: Silvia Canivell; Olivier Muller; Baris Gencer; Dik Heg; Roland Klingenberg; Lorenz Räber; David Carballo; Christian Matter; Thomas Lüscher; Stephan Windecker; François Mach; Nicolas Rodondi; David Nanchen Journal: PLoS One Date: 2018-04-12 Impact factor: 3.240