Routinely-feasible multiple biomarkers score to predict prognosis after revascularized STEMI

IntroductionWe assessed the long-term prognostic value of an easy-to-do multiple cardiac biomarkers score after a revascularized acute myocardial infarction (MI) in order to evaluate a multimarker approach to risk stratification, based on routine biomarkers.Material and methodsBlood samples from 138 patients hospitalized with acute myocardial infarction and successfully treated by primary coronary intervention (with TIMI 3 flow) were subsequently tested for creatinin level at admittance and then BNP, hsCRP, troponin I from Day 0 to day 7. The primary endpoint was a clinical evaluation comprising: new hospitalization for cardiac reasons, acute coronary events (acute coronary syndrome), and death.ResultsDuring the median follow-up period of 11.01 months [9.44–12.59], 47 events were recorded. All the following markers were able to predict events: creatinemia on admission (p = 0.0057), CRP on day 3 (p, troponin I on day 1 (p < 0.001), BNP (p < 0.0001) and biological multimarker score (p < 0.0001).Clinical events were predicted with a hazard ratio (HR) of respectively 3.30 [2.88–12.30] in BNP Q4 as compared to the three lower quartiles (Q1–3), and 3.15 [2.75–21.00] for the Multimarker approach. The multimarker score was not significantly better than BNP on day 1 alone (p = 0.77), troponin on day 1 alone (p = 0.43), creatininemia on admission (p = 0.19) or CRPhs on day 3 alone (p = 0.054). Nevertheless, the Multimarker approach leads to the selection of a smaller, hence more manageable, high-risk population (13% versus 25%).ConclusionAmong 138 subjects admitted for acute MI, and all successfully revascularized, a routinely multimarker approach with BNP, hsCRP, creatininemia, troponin I, is feasible.BNP is the most powerful marker, and this multimarker approach renders additional prognostic information helping to identify patients with high-risk to clinical events.