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30-06-2011 | Cardiology | Article

Multimarker model predicts long-term CV risk after NSTE ACS


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MedWire News: European researchers have unveiled a new multimarker risk model that predicts long-term cardiovascular (CV) risk in non-ST-segment elevation acute coronary syndrome (NSTE ACS) patients.

"With the help of this model in conjunction with the careful selection of other biomarkers and clinical variables, we might be able to provide tailored treatment for the individual patient not only at the time of hospitalization but also following discharge," write Eric Boersma (Erasmus Medical Center, Rotterdam, The Netherlands) and colleagues in the journal Heart.

The risk model includes seven biomarkers: high-sensitivity C-reactive protein (hsCRP), myeloperoxidase, pregnancy-associated plasma protein A (PAPP), placental growth factor (PlGF), soluble CD40 ligand (sCD40L), interleukin 10 (IL-10), and troponin-T (TnT).

The researchers explain that these seven biomarkers have previously been found to independently predict future coronary events.

Boersma et al assessed the composite endpoint of all-cause mortality and nonfatal myocardial infarction (MI) in 1090 NSTE ACS patients over a median follow-up period of 4 years.

Blood samples were drawn 8.7 hours after the last episode of angina, and before PCI and adverse events.

The findings showed that 15.3% of patients reached the composite endpoint. Multivariate analysis adjusted for other biomarkers and clinical characteristics revealed that admission levels of TnT greater than 0.01 µg/l, IL-10 less than 3.5 ng/l, myeloperoxidase greater than 350 µg/l, and PlGF greater than 27 ng/l were independently associated with an increased risk for all-cause mortality and nonfatal MI during the follow-up period, at hazard ratios of 1.8, 1.7, 1.5, and 1.9, respectively.

However, hsCRP, PAPP, and sCD40L, were only associated with the composite endpoint in univariate analysis.

The researchers created a multimarker risk model consisting of TnT, IL-10, myeloperoxidase, and PlGF for 4-year mortality and nonfatal MI, by counting the presence or absence of an abnormal biomarker value that significantly predicted risk for an event.

The proportions of patients with zero, one, two, or three or more abnormal biomarker levels were 5.2%, 22.1%, 43.5%, and 29.2%, respectively, and the model predicted 4-year nonfatal MI rates that varied between 6.0% (all markers normal) and 35.8% (three or more biomarkers abnormal).

"The use of combinations of selected biomarkers adds incremental predictive value to further risk stratification in an otherwise seemingly homogeneous NSTE ACS population," conclude the authors.

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Piriya Mahendra

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