Multimarker approach predicts adverse cardiovascular events in women evaluated for suspected ischemia: Results from the National Heart, Lung, and Blood Institute-Sponsored Women's Ischemia syndrome Evaluation

Abstract

Background: Inflammatory marker and hemoglobin levels (eg biomarkers) considered separately, predict adverse events in selected populations. Hypothesis: A multiple biomarker approach predicts adverse events in women referred for evaluation of ischemia. Methods: We investigated associations between biomarkers (high sensitivity C-reactive protein, interleukin-6, serum amyloid-A, and hemoglobin levels) with adverse outcomes in women referred for coronary angiography for suspected ischemia in theNational Heart, Lung, and Blood Institute (NHLBI)-sponsoredWomen's Ischemia Syndrome Evaluation (WISE). Results: Among 595 women (mean age 58 years, ejection fraction [EF] 65%,majority without coronary stenosis ≥50%) followed for 3.6 ± 1.8 years (mean ± SD), those without abnormal markers had fewer events (11.6%) compared to those with 1 (18.4%), 2 (20.9%), or 3 (37%) abnormal markers (p<0.001 for trend). Women without abnormal markers had fewer deaths (1.6%) than women with 1 (6.1%), 2 (9.1%), or 3 (17%) abnormal markers (p<0.001 for trend). Adding low hemoglobin was associated with higher adverse event and all-cause mortality rates. In multivariate analysis, as the number of abnormal biomarkers increased risk increased. Women with 3 or 4 abnormal biomarkers were approximately 10-20 times more likely to die (p<0.05). Biomarkers added to the predictive information provided by the Framingham Risk Score. Conclusions: Among women undergoing coronary angiography for suspected ischemia, a multibiomarker approach predicted adverse events. Biomarkers added prognostic information beyond that obtained from traditional risk factors. © 2009 Wiley Periodicals, Inc.