Biomarkers on Admission for the Prediction of Cardiovascular Events After Primary Stenting in Patients with ST‐Elevation Myocardial Infarction

Abstract

Background: Several cardiac biomarkers have been shown to have predictive values for the development of cardiovascular disease and clinical outcome after events, and are now broadly used by clinicians. Little is known about the utility of these biomarker values on admission in ST-elevation myocardial infarction (STEMI) cases of primary drug-eluting stent (DES) implantation and intense medical therapy. Hypothesis: Because little is known about the utility of these biomarkers on admission in ST-elevation myocardial infarction (STEMI) in cases primary drug-eluting stent (DES) implantation and intense medical therapy, we evaluated clinical outcomes. Methods: We enrolled 207 consecutive STEMI patients treated with primary stenting (mean age, 57.3±12.0 y). We evaluated the association between B-type natriuretic peptide (BNP), cardiac troponin I (cTnI), highsensitivity C-reactive protein (hs-CRP) on admission, and death, reinfarction, and new or worsening congestive heart failure (CHF) through 1 y. Results: In backward-elimination models including all biomarkers, only the cTnI level was retained as a predictor of 1-y CHF (odds ratio [OR]: 1.017, 95% confidence interval [CI]: 1.001-1.034, p = 0.039). There were no predictors in terms of 1-y death, reinfarction, and composite endpoint. When we applied a simple score system, in which patients were categorized on the basis of the number of elevated biomarkers, the 1-y risks of death (p = 0.600), reinfarction (p = 0.185), and composite endpoint (p = 0.620) did not increase in proportion to the number of elevated biomarkers on admission. One-y CHF only tended to increase according to the number of elevated biomarkers (p = 0.067). Conclusions:The use of cardiac biomarkers on admission, in each or in combination, had only a minimal impact for the prediction of long-term cardiovascular events after primary stenting in STEMI patients.

Circulating Levels of IL‐6 Receptor and gp130 and Long‐Term Clinical Outcomes in ST‐Elevation Myocardial Infarction

“…27,28 Levels of IL-6, however, were not associated with the composite of clinical events or all-cause mortality in the present population, in contrast to other reports. 9,29 We have earlier described significant associations in the present cohort of STEMI patients between IL-6 and CRP and myocardial necrosis defined as peak troponin T, 17 whereas sIL-6R and sgp130 did not show any associations with peak troponin T. Why high levels of IL-6 or troponin T were not related to clinical events or all-cause mortality in this cohort of PCI-treated patients is unclear, but a similar lack of findings between peak troponin levels and subsequent clinical events have also been reported from other STEMI cohorts. 9,29…”

Enhanced Inflammation is a Marker for Risk of Post-Infarct Ventricular Dysfunction and Heart Failure

“…At present, the potential value of CRP for the prediction of long-term LVSD and HF in patients with STEMI undergoing PCI and guideline-based therapies has not been definitely assessed [14,27]. Previous studies have been limited by heterogenous populations with acute coronary syndromes that were frequently untreated with PCI, small sample size, a lack of multiple high-sensitivity CRP measurements, absence of neurohormonal activation assessment, lack of long-term monitoring of LVEF and HF, and omission of long-term LVSD and HF as clinical endpoints [14,[16][17][18][21][22][23][24][25][26][27][28][29][30][31][32][33][34].The purpose of this study was to assess the value of high-sensitivity CRP in a homogenous population of patients with first STEMI undergoing primary PCI and guideline-based therapies for predicting the risk of: (i) LVSD at 6 months after hospital discharge (LVSD 6M ), which was the primary study endpoint; and (ii) the need for hospitalization for HF in patients with LVSD 6M in long-term multi-year follow-up, which was the secondary study endpoint. This secondary endpoint was chosen because hospitalization for HF is associated with subsequent increase in risk of mortality [8].We performed a single-center prospective cohort study with rigorous selection criteria, adequate sample size, and long-term follow-up data based on multiple assessment time-points: baseline, 24 h, and discharge during index hospitalization for STEMI, 1 month and 6 months after discharge, and long-term multi-year follow-up.…”

B-type Natriuretic Peptide as Predictor of Heart Failure in Patients with Acute ST Elevation Myocardial Infarction, Single-vessel Disease, and Complete Revascularization: Follow-up Study

“…Patients were divided in 2 groups depending on whether their BNP values were lower than 80 pg/ mL at admission, 24 hours, and 7 days. The cut-off point of BNP levels was set to 80 pg/mL, as described in previous studies (10,11). ROC curve analysis showed that values of BNP≥80 pg/mL had 60.0% sensitivity and 82.2% specificity for predicting reduced ejection fraction after 12 months (Figure 2).…”