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), high-sensitivity 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. © 2008 Wiley Periodicals, Inc.