TY - JOUR
T1 - Serially measured high-sensitivity cardiac troponin T, N-terminal-pro-B-type natriuretic peptide, high-sensitivity C-reactive protein, and growth differentiation factor 15 for risk assessment after acute coronary syndrome
T2 - the BIOMArCS cohort
AU - Gürgöze, Muhammed T.
AU - Akkerhuis, K. Martijn
AU - Oemrawsingh, Rohit M.
AU - Umans, Victor A. W. M.
AU - Kietselaer, Bas
AU - Schotborgh, Carl E.
AU - Ronner, Eelko
AU - Lenderink, Timo
AU - Aksoy, Ismail
AU - van der Harst, Pim
AU - Asselbergs, Folkert W.
AU - Maas, Arthur C.
AU - Oude Ophuis, Anton J.
AU - Krenning, Boudewijn
AU - de Winter, Robbert J.
AU - The, Salem H. K.
AU - Wardeh, Alexander J.
AU - Hermans, Walter R. M.
AU - Cramer, G. Etienne
AU - van Gorp, Ina
AU - de Rijke, Yolanda B.
AU - van Schaik, Ron H. N.
AU - Boersma, Eric
N1 - Funding Information: The authors are grateful for all participating centres for carrying out the study procedures including data collection and the analysts who have carefully and systematically analysed the blood samples. F.W.A. is supported by UCL Hospitals National Institute for Health and Care Research Biomedical Research Centre. Funding Information: Roche Diagnostics provided assays and kits in support of this work (‘COBAS C, COBAS E and ELECSYS are trademarks of Roche’). This study was supported and funded by the Netherlands Heart Foundation (grant number 2007B012); The Netherlands Heart Institute-Interuniversity Cardiology Institute of Netherlands (project number 071.01); the Working Group of Cardiovascular Research Netherlands, all of which are non-commercial funding bodies, and an unrestricted research grant was further obtained from Eli Lilly, the Netherlands. Publisher Copyright: © 2023 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2023/7/1
Y1 - 2023/7/1
N2 - Aims: Evidence regarding the role of serial measurements of biomarkers for risk assessment in post-acute coronary syndrome (ACS) patients is limited. The aim was to explore the prognostic value of four, serially measured biomarkers in a large, real-world cohort of post-ACS patients. Methods and results: BIOMArCS is a prospective, multi-centre, observational study in 844 post-ACS patients in whom 12 218 blood samples (median 17 per patient) were obtained during 1-year follow-up. The longitudinal patterns of high-sensitivity cardiac troponin T (hs-cTnT), N-terminal-pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP), and growth differentiation factor 15 (GDF-15) were analysed in relation to the primary endpoint (PE) of cardiovascular mortality and recurrent ACS using multivariable joint models. Median age was 63 years, 78% were men and the PE was reached by 45 patients. The average biomarker levels were systematically higher in PE compared with PE-free patients. After adjustment for 6-month post-discharge Global Registry of Acute Coronary Events score, 1 standard deviation increase in log[hs-cTnT] was associated with a 61% increased risk of the PE [hazard ratio (HR) 1.61, 95% confidence interval (CI) 1.02-2.44, P = 0.045], while for log[GDF-15] this was 81% (HR 1.81, 95% CI 1.28-2.70, P = 0.001). These associations remained significant after multivariable adjustment, while NT-proBNP and hs-CRP were not. Furthermore, GDF-15 level showed an increasing trend prior to the PE (Structured Graphical Abstract). Conclusion: Longitudinally measured hs-cTnT and GDF-15 concentrations provide prognostic value in the risk assessment of clinically stabilized patients post-ACS. Clinical Trial Registration: The Netherlands Trial Register. Currently available at URL https://trialsearch.who.int/; Unique Identifiers: NTR1698 and NTR1106.
AB - Aims: Evidence regarding the role of serial measurements of biomarkers for risk assessment in post-acute coronary syndrome (ACS) patients is limited. The aim was to explore the prognostic value of four, serially measured biomarkers in a large, real-world cohort of post-ACS patients. Methods and results: BIOMArCS is a prospective, multi-centre, observational study in 844 post-ACS patients in whom 12 218 blood samples (median 17 per patient) were obtained during 1-year follow-up. The longitudinal patterns of high-sensitivity cardiac troponin T (hs-cTnT), N-terminal-pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP), and growth differentiation factor 15 (GDF-15) were analysed in relation to the primary endpoint (PE) of cardiovascular mortality and recurrent ACS using multivariable joint models. Median age was 63 years, 78% were men and the PE was reached by 45 patients. The average biomarker levels were systematically higher in PE compared with PE-free patients. After adjustment for 6-month post-discharge Global Registry of Acute Coronary Events score, 1 standard deviation increase in log[hs-cTnT] was associated with a 61% increased risk of the PE [hazard ratio (HR) 1.61, 95% confidence interval (CI) 1.02-2.44, P = 0.045], while for log[GDF-15] this was 81% (HR 1.81, 95% CI 1.28-2.70, P = 0.001). These associations remained significant after multivariable adjustment, while NT-proBNP and hs-CRP were not. Furthermore, GDF-15 level showed an increasing trend prior to the PE (Structured Graphical Abstract). Conclusion: Longitudinally measured hs-cTnT and GDF-15 concentrations provide prognostic value in the risk assessment of clinically stabilized patients post-ACS. Clinical Trial Registration: The Netherlands Trial Register. Currently available at URL https://trialsearch.who.int/; Unique Identifiers: NTR1698 and NTR1106.
KW - Acute coronary syndrome
KW - Biomarkers
KW - Prognosis
KW - Repeated measurements
KW - Risk assessment
UR - http://www.scopus.com/inward/record.url?scp=85165722967&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/ehjacc/zuad042
DO - https://doi.org/10.1093/ehjacc/zuad042
M3 - Article
C2 - 37096818
SN - 2048-8734
VL - 12
SP - 451
EP - 461
JO - European heart journal. Acute cardiovascular care
JF - European heart journal. Acute cardiovascular care
IS - 7
ER -