A statistical approach to evaluate the performance of cardiac biomarkers in predicting death due to acute myocardial infarction: Time dependent ROC curve

Abstract

Background/aim: Myoglobin, cardiac troponin T, B-type natriuretic peptide (BNP), and creatine kinase isoenzyme MB (CK-MB) are frequently used biomarkers for evaluating risk of patients admitted to an emergency department with chest pain. Recently, timedependent receiver operating characteristic (ROC) analysis has been used to evaluate the predictive power of biomarkers where disease status can change over time. We aimed to determine the best set of biomarkers that estimate cardiac death during follow-up time. We also obtained optimal cut-off values of these biomarkers, which differentiates between patients with and without risk of death. A web tool was developed to estimate time intervals in risk.Materials and methods: A total of 410 patients admitted to the emergency department with chest pain and shortness of breath were included. Cox regression analysis was used to determine an optimal set of biomarkers that can be used for estimating cardiac death and to combine the significant biomarkers. Time-dependent ROC analysis was performed for evaluating performances of significant biomarkers and a combined biomarker during 240 h. The bootstrap method was used to compare statistical significance and the Youden index was used to determine optimal cut-off values.Results: Myoglobin and BNP were significant by multivariate Cox regression analysis. Areas under the time-dependent ROC curves of myoglobin and BNP were about 0.80 during 240 h, and that of the combined biomarker (myoglobin + BNP) increased to 0.90 during the first 180 h. Conclusion:Although myoglobin is not clinically specific to a cardiac event, in our study both myoglobin and BNP were found to be statistically significant for estimating cardiac death. Using this combined biomarker may increase the power of prediction. Our web tool can be useful for evaluating the risk status of new patients and helping clinicians in making decisions.

From Classic to Modern Prognostic Biomarkers in Patients with Acute Myocardial Infarction

“…Furthermore, even if studies 20 years ago identified myoglobin as a predictive factor for short- or long-term death, there are little data from the previous five years to indicate its efficacy for prognoses in patients with ACS [ 141 , 142 ]. There is one study that found that when the log (myoglobin) transformation increased by one unit, the risk of mortality increased by 6.9 times [ 143 ].…”

Novel Cardiac Biomarkers H-FABP and GPBB for Early Detection and Prognosis of Acute Myocardial Infarction

“…While research conducted two decades ago suggested that myoglobin could improve ACS diagnosis, recent data supporting this claim are lacking (Bodí et al, 2003). One study indicated a 6.9-fold increase in the risk of death with each unit increase in log-transformed myoglobin levels (Karaismailoğlu et al, 2018).…”