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

Aleksandar Serafimov; Darko Donevski; Marija Karakolevska Ilova; Elena Joveva; Kristina Todosieva Serafimova; Sasko Kedev; Marija Vavlukis

doi:10.3889/oamjms.2022.7978

Authors

Aleksandar Serafimov Department of Cardiology, Clinical Hospital Shtip, Shtip, Macedonia https://orcid.org/0000-0003-3638-1397
Darko Donevski Department of Cardiology, University Clinic of Cardiology, Skopje, Macedonia
Marija Karakolevska Ilova Department of Oncology and Radiotherapy, Clinical Hospital Shtip, Shtip, Macedonia
Elena Joveva Department of Neurology, Clinical Hospital Shtip, Shtip, Macedonia
Kristina Todosieva Serafimova Department of Radiology, General Hospital Kochani, Kochani, Macedonia
Sasko Kedev Department of Cardiology, University Clinic of Cardiology, Skopje, Macedonia
Marija Vavlukis Department of Cardiology, University Clinic of Cardiology, Skopje, Macedonia https://orcid.org/0000-0002-4479-6691

DOI:

https://doi.org/10.3889/oamjms.2022.7978

Keywords:

Myocardial infarction, Cardiac biomarker, Left ventricular function, Prognosis, Major adverse cardiac events

Abstract

Background: Given the number of prognostic studies, both short- and long-termed, in patients with myocardial infarction (MI), the data on predicting major adverse cardiac events (MACE) following discharge still remains limited. Aim: to identify early predictors of MACE in MI patients, that underwent Primary Percutaneous Coronary Intervention (pPCI), with special emphasis on multiple cardiac biomarkers. Materials and methods: we analysed clinical, LV functional, angiographic variables, as well cardiac troponin, 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 population were 150 consecutive patients treated for acute myocardial infarction. 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=0,07), 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 .640, and .658, p=0.025 and 0.011 respectively). Conclusion: The combination of biomarkers for myocardial stress and inflammation improves the prediction of major adverse cardiac events in MI survivors.

Keywords: myocardial infarction, cardiac biomarkers, cardiac troponin, natriuretic peptide, prognosis, major adverse cardiac events (MACE), cardiac death

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Chowdhury N, Khan MA, Hoque MM. Prognostic significance of B type natriuretic peptide in acute coronary syndrome. Chatt Maa Shi Hosp Med Coll J. 2014;13:78-88. https://doi.org/10.3329/cmoshmcj.v13i2.21079 DOI: https://doi.org/10.3329/cmoshmcj.v13i2.21079

Kontos MC, Lanfear DE, Gosch K, Daugherty SL, Heidenriech P, Spertus JA. Prognostic value of serial N-Terminal pro-brain natriuretic peptide testing in patients with acute myocardial infarction. Am J Cardiol. 2017;120(2):181-5. https://doi.org/10.1016/j.amjcard.2017.04.004 PMid:28599802 DOI: https://doi.org/10.1016/j.amjcard.2017.04.004

Goff DC Jr., Lloyd-Jones DM, Bennett G, Coady S, D’Agostino RB, Gibbons R, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: A report of the American college of cardiology/American heart association task force on practice guidelines. Circulation. 2014;129(25):S49-73. https://doi.org/10.1161/01.cir.0000437741.48606.98 PMid:24222018 DOI: https://doi.org/10.1161/01.cir.0000437741.48606.98

Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: Executive summary: A report of the American college of cardiology/ American heart association task force on clinical practice guidelines. Circulation. 2019;140(11):e563-595. https://doi.org/10.1161/CIR.00000000 00000677 PMid:30879339 DOI: https://doi.org/10.1161/CIR.0000000000000724

Siemelink MA, Zeller T. Biomarkers of coronary artery disease: The promise of the transcriptome. Curr Cardiol Rep. 2014;16(8):513. https://doi.org/10.1007/s11886-014-0513-4 PMid:24950674 DOI: https://doi.org/10.1007/s11886-014-0513-4

Thøgersen M, Frydland M, Helgestad OK, Jensen LO, Josiassen J, Goetze JP, et al. Admission biomarkers among patients with acute myocardial-infarction related cardiogenic shock with or without out-of-hospital cardiac arrest an exploratory study. Biomarkers. 2021;26(7):1-21. https://doi.org/10.1080/1354750X.2021.1955975 PMid:34259098 DOI: https://doi.org/10.1080/1354750X.2021.1955975

Nagasawa A, Otake H, Kawamori H, Toba T, Sugizaki Y, Takeshige R, et al. Relationship among clinical characteristics, morphological culprit plaque features, and long-term prognosis in patients with acute coronary syndrome. Int J Cardiovasc Imaging. 2021;37(10):2827-37. https://doi.org/10.1007/s10554-021-02252-w PMid:33982195 DOI: https://doi.org/10.1007/s10554-021-02252-w

Wu H, Wang C, Tuerhongjiang G, Qiao X, Hua Y, She J, et al. Circulating lipid and lipoprotein profiles and their correlation to cardiac function and cardiovascular outcomes in patients with acute myocardial infarction. J Investig Med. 2021;69(7):1310-7. https://doi.org/10.1136/jim-2021-001803 PMid:33972383 DOI: https://doi.org/10.1136/jim-2021-001803

Liu HH, Cao YX, Jin JL, Guo YL, Zhu CG, Wu NQ, et al. Prognostic value of NT-proBNP in patients with chronic coronary syndrome and normal left ventricular systolic function according to glucose status: A prospective cohort study. Cardiovasc Diabetol. 2021;20(1):84. https://doi.org/10.1186/s12933-021-01271-0 PMid:33888145 DOI: https://doi.org/10.1186/s12933-021-01271-0

Nestelberger T, Boeddinghaus J, Lopez-Ayala P, Kaier TE, Marber M, Gysin V, et al. Cardiovascular biomarkers in the early discrimination of Type 2 myocardial infarction. JAMA Cardiol. 2021;6(7):771-80. https://doi.org/10.1001/jamacardio.2021.0669 PMid:33881449 DOI: https://doi.org/10.1001/jamacardio.2021.0669

Węgiel M, Rakowski T. Circulating biomarkers as predictors of left ventricular remodeling after myocardial infarction. Postepy Kardiol Interwencyjnej. 2021;17(1):21-32. https://doi.org/10.5114/aic.2021.104764 PMid:33868414 DOI: https://doi.org/10.5114/aic.2021.104764

Gao S, Liu Q, Chen H, Yu M, Li H. Predictive value of stress hyperglycemia ratio for the occurrence of acute kidney injury in acute myocardial infarction patients with diabetes. BMC Cardiovasc Disord. 2021;21(1):157. https://doi.org/10.1186/s12872-021-01962-2 PMid:33781208 DOI: https://doi.org/10.1186/s12872-021-01962-2

Somuncu MU, Avci A, Kalayci B, Gudul NE, Tatar FP, Demir AR, et al. Predicting long-term cardiovascular outcomes in myocardial infarction survivors using multiple biomarkers. Biomark Med. 2021;15(11):899-910. https://doi.org/10.2217/bmm-2020-0875 PMid:34241548 DOI: https://doi.org/10.2217/bmm-2020-0875

Gong X, Zhang T, Feng S, Song D, Chen Y, Yao T, et al. Association between N-terminal pro-BNP and 12 months major adverse cardiac events among patients admitted with NSTEMI. Ann Palliat Med. 2021;10(5):5231-43. https://doi.org/10.21037/apm-20-2538 PMid:34044561 DOI: https://doi.org/10.21037/apm-20-2538

Khan S, Rasool ST. Current use of cardiac biomarkers in various heart conditions. Endocr Metab Immune Disord Drug Targets. 2021;21(6):980-93. https://doi.org/10.2174/1871530320999200831171748 PMid:32867665 DOI: https://doi.org/10.2174/1871530320999200831171748

McKechnie DG, Papacosta AO, Lennon LT, Welsh P, Whincup PH, et al. Inflammatory markers and incident heart failure in older men: The role of NT-proBNP. Biomark Med. 2021;15(6):413-25. https://doi.org/10.2217/bmm-2020-0669 PMid:33709785 DOI: https://doi.org/10.2217/bmm-2020-0669

Han JH, Hwang SO, Cha KC, Roh YI, Kim SJ, Kim HS, et al. High-sensitivity troponin I assay for differential diagnosis of new-onset myocardial infarction in patients with acute decompensated heart failure. Yonsei Med J. 2021;62(2):129-36. https://doi.org/10.3349/ymj.2021.62.2.129 PMid:33527792 DOI: https://doi.org/10.3349/ymj.2021.62.2.129

Oleynikov VE, Dushina EV, Golubeva AV, Barmenkova JA. Early predictors of heart failure progression in patients after myocardial infarction. Kardiologiia. 2020;60(11):1309. https://doi.org/10.18087/cardio.2020.11.n1309 PMid:33487154 DOI: https://doi.org/10.18087/cardio.2020.11.n1309

Yoshioka N, Takagi K, Tanaka A, Morita Y, Yoshida R, Kanzaki Y, et al. The mid-term mortality and mode of death in survivors with ST-elevation myocardial Infarction. Intern Med. 2021;60(11):1665-74. https://doi.org/10.2169/internalmedicine.6549-20 PMid:33390500 DOI: https://doi.org/10.2169/internalmedicine.6549-20

Han MM, Zhao WS, Wang X, He S, Xu XR, Dang CJ, et al. Echocardiographic parameters predict short- and long-term adverse cardiovascular events in patients with acute myocardial infarction. Int J Gen Med. 2021;14:2297-303. https://doi.org/10.2147/IJGM.S304449 PMid:34113159 DOI: https://doi.org/10.2147/IJGM.S304449

Prastaro M, Pirozzi E, Gaibazzi N, Paolillo S, Santoro C, Savarese G, et al. Expert review on the prognostic role of echocardiography after acute myocardial infarction. J Am Soc Echocardiogr. 2017;30(5):431-43.e2. https://doi.org/10.1016/j.echo.2017.01.020 PMid:28477781 DOI: https://doi.org/10.1016/j.echo.2017.01.020

Kamran S, Akhtar N, Singh R, Imam Y, Haroon KH, Amir N, et al. Association of major adverse cardiovascular events in patients with stroke and cardiac wall motion abnormalities. J Am Heart Assoc. 2021;10:e020888. https://doi.org/10.1161/JAHA.121.020888 PMid:34259032 DOI: https://doi.org/10.1161/JAHA.121.020888

Schartum-Hansen H, Løland KH, Svingen GF, Seifert R, Pedersen ER, Nordrehaug JE, et al. Use of loop diuretics is associated with increased mortality in patients with suspected coronary artery disease, but without systolic heart failure or renal Impairment: An observational study using propensity score matching. PLoS One. 2015;10(6):e0124611. https://doi.org/10.1371/journal.pone.0124611 PMid:26030195 DOI: https://doi.org/10.1371/journal.pone.0124611

Chen Y, Tao Y, Zhang L, Xu W, Zhou X. Diagnostic and prognostic value of biomarkers in acute myocardial infarction. Postgrad Med J. 2019;95(1122):210-6. https://doi.org/10.1136/postgradmedj-2019-136409 PMid:30948439 DOI: https://doi.org/10.1136/postgradmedj-2019-136409

Magnussen C, Blankenberg S. Biomarkers for heart failure: Small molecules with highclinical relevance. J Intern Med. 2018;283(6):530-43. https://doi.org/10.1111/joim.12756 PMid:29682806 DOI: https://doi.org/10.1111/joim.12756

Steen H, Futterer S, Merten C, Jünger C, Katus HA, Giannitsis E. Relative role of NT-proBNP and cardiac troponin T at 96 hours for estimation of infarct size and left ventricular function after acute myocardial infarction. J Cardiovasc Magn Reson. 2007;9(5):749-58. https://doi.org/10.1080/10976640701544589 PMid:17891611 DOI: https://doi.org/10.1080/10976640701544589

Fiechter M, Ghadri JR, Jaguszewski M, Siddique A, Vogt S, Haller RB, et al. Impact of inflammation on adverse cardiovascular events in patients with acute coronary syndromes. J Cardiovasc Med (Hagerstown). 2013;14(11):807-14. https://doi.org/10.2459/ JCM.0b013e3283609350 PMid:23572059 DOI: https://doi.org/10.2459/JCM.0b013e3283609350