Risk Assessment after ST‐Segment Elevation Myocardial Infarction: Can Biomarkers Improve the Performance of Clinical Variables?

Abstract

Introduction: Myocardial infarction with ST‐segment elevation (STEMI) is the coronary artery disease associated with the highest risk of morbimortality; however, this risk is heterogeneous, usually being evaluated by clinical scores. Risk assessment is a key factor in personalized clinical management of patients with this disease. Aim: The aim of this study was to assess whether some new cardiac biomarkers considered alone, combined in a multibiomarker model or in association with clinical variables, improve the short‐ and long‐term risk stratification of STEMI patients. Materials and Methods: This was a retrospective observational study of 253 patients with STEMI. Blood samples were obtained before or during the angiography. The assessed biomarkers were C‐terminal fragment of insulin‐like growth factor binding protein‐4 (CT‐IGFBP4), high sensitive cardiac troponin T (hs‐cTnT), N‐terminal fragment of probrain natriuretic peptide (NT‐proBNP), and growth differentiation factor 15 (GDF‐15); they reflect different cardiovascular (CV) physiopathological pathways and underlying pathologies. We registered in‐hospital and follow‐up mortalities and their causes (cardiovascular and all‐cause) and major adverse cardiac events (MACE) during a two year follow‐up. Discrimination, survival analysis, model calibration, and reclassification of the biomarkers were comprehensively evaluated. Results and Discussion: In total, 55 patients (21.7%) died, 33 in‐hospital and 22 during the follow‐up, most of them (69.1%) from CV causes; 37 MACE occurred during follow‐up. Biomarkers showed good prognostic ability to predict mortality, alone and combined with the multibiomarker model. A predictive clinical model based on age, Killip–Kimball class, estimated glomerular filtration rate (eGFR), and heart rate was derived by multivariate analysis. GDF‐15 and NT‐proBNP significantly improved risk assessment of the clinical model, as shown by discrimination, calibration, and reclassification of all the end‐points except for all‐cause mortality. The combination of NT‐proBNP and hs‐cTnT improved CV mortality prediction. Conclusions: GDF‐15 and NT‐proBNP added value to the usual risk assessment of STEMI patients.