Incremental Value of Cardiac Biomarkers in Mid-term Prognosis of Patients with Acute Coronary Syndrome

Abstract

BACKGROUND: Given the number of prognostic studies, both short-and long-termed, in patients with myocardial infarction (MI), the data on predictors of major adverse cardiac events (MACE) following discharge still remains limited. Assessment of left ventricular (LV) function, combined with the use of cardiac biomarkers, such as NT-proBNP can help in the early identification of patients at risk of developing heart failure and/or other MACE in acute MI (AMI) survivors. AIM: The aim of the study was to identify early predictors of MACE in MI patients, that underwent primary percutaneous coronary intervention, with special emphasis on cardiac biomarkers. MATERIALS AND METHODS: We analyzed clinical, LV functional, angiographic variables, as well cardiac troponin (hsTn), a marker of myocardial necrosis, natriuretic peptide (NT-proBNP), a marker of myocardial stress, and white blood cells (WBC), as a marker of inflammation. The study was designed as longitudinal, prospective observational cohort study undertaken on 150 AMI patients hospitalized at University Clinic of Cardiology over the period of September 2018 to March 2019. Inclusion criteria: All incomers hospitalized for AMI over the aforementioned period who were willing to participate in the study and gave signed informed consent. Exclusion criteria: Patients who were not consented to participate in the study, patients who suffered in-hospital mortality over the index hospitalization and those with the previous HF and/or AMI. IBM SPSS statistical software version 22 was used for statistical analysis. Descriptive and comparative statistical methods were applied. Continuous variables were presented as means, while categorical as frequencies and percentages. Comparative statistic tests: Chi-square test, for variables with dichotomous distribution, t-test and one-way ANOVA for continuous variables with two or more categories were applied. Risk ratios with 95% confidence intervals were calculated, and the significance was determined using Cochran and Mantel-Haenszel test (at the level of <0.05). Receiver operator characteristic curves (ROC) were used for prediction capability. Correlations, uni-and multivariate linear, and logistic regression analysis were undertaken to identify significantly associated variables. RESULTS: The average follow-up period was 31 months. In total, 26 patients suffered from at least one MACE. Multivariate logistic regression analysis identified several independent predictors: NT-proBNP (p = 0.007), number of diseased vessels (p = 0.027), and need for loop diuretic therapy (p = 0.050). ROC curve demonstrated excellent discriminatory function for MACE of NT-proBNP and WBC (area under the curve 0.640, and 0.658, p = 0.025 and 0.011, respectively). CONCLUSION: The combination of biomarkers for myocardial stress and inflammation improves the prediction of MACE in MI survivors.