TY - JOUR
T1 - "Upstream markers" provide for early identification of patients at high risk for myocardial necrosis and adverse outcomes
AU - Kavsak, Peter A.
AU - Ko, Dennis T.
AU - Newman, Alice M.
AU - Palomaki, Glenn E.
AU - Lustig, Viliam
AU - MacRae, Andrew R.
AU - Jaffe, Allan S.
N1 - Funding Information:
This work was supported by a grant from the Canadian Institutes of Health Research. The Cell Adhesion array was contributed for the study by Randox Laboratories Ltd. Special thanks to the staff at the Clinical Research and Clinical Trials Laboratory at the Hamilton Regional Laboratory Medicine Program and Randox Laboratories Ltd. for technical support.
PY - 2008/1
Y1 - 2008/1
N2 - Background: For patients presenting with acute coronary syndrome (ACS) to the emergency department, early identification of those that are at high risk for subsequent myocardial necrosis or adverse outcomes would allow earlier or more aggressive treatment. We determined if a panel of biomarkers can be used to identify high risk patients. Methods: A cohort (84 females/132 males) from our 1996 ACS study population that had EDTA specimens stored (- 70 °C) was selected and the earliest available specimen was analyzed for 11 biomarkers (IL-6, IL-8, MCP-1, VEGF, L-selectin, P-selectin, E-selectin, ICAM-1, VCAM-1, NT-proBNP, cTnT). These data were linked to the existing cTnI and health outcome databases for this population. ROC curve analysis for myocardial necrosis (i.e., peak cTnI > 0.04 μg/l) identified 3 candidate biomarkers. These 3 biomarkers were applied together to generate a panel test (2 of the 3 biomarkers increased for a positive result) and assessed for its ability to identify patients at risk for myocardial necrosis and the combined endpoint of death, myocardial infarction (MI) and heart failure (HF). Results: The panel test (IL-6, NT-proBNP, E-selectin) alone detected 60% (95% CI: 49-69; false positive rate: 26%) of subjects that would be classified with myocardial necrosis. Kaplan-Meier and Cox proportional analyses indicated that patients positive by the biomarker panel (including those with cTnI ≤ 0.04 μg/l) had significantly worse outcomes (death/MI/HF) as compared to those negative by both cTnI and the panel test. Conclusion: A biomarker panel analyzed early after pain onset can identify individuals at risk for both myocardial necrosis and the combined endpoint of death/MI/HF. Additional prospective studies are required to assess this panel for both early MI detection and to further refine which health outcomes (death, MI, HF) are associated with positive panel results.
AB - Background: For patients presenting with acute coronary syndrome (ACS) to the emergency department, early identification of those that are at high risk for subsequent myocardial necrosis or adverse outcomes would allow earlier or more aggressive treatment. We determined if a panel of biomarkers can be used to identify high risk patients. Methods: A cohort (84 females/132 males) from our 1996 ACS study population that had EDTA specimens stored (- 70 °C) was selected and the earliest available specimen was analyzed for 11 biomarkers (IL-6, IL-8, MCP-1, VEGF, L-selectin, P-selectin, E-selectin, ICAM-1, VCAM-1, NT-proBNP, cTnT). These data were linked to the existing cTnI and health outcome databases for this population. ROC curve analysis for myocardial necrosis (i.e., peak cTnI > 0.04 μg/l) identified 3 candidate biomarkers. These 3 biomarkers were applied together to generate a panel test (2 of the 3 biomarkers increased for a positive result) and assessed for its ability to identify patients at risk for myocardial necrosis and the combined endpoint of death, myocardial infarction (MI) and heart failure (HF). Results: The panel test (IL-6, NT-proBNP, E-selectin) alone detected 60% (95% CI: 49-69; false positive rate: 26%) of subjects that would be classified with myocardial necrosis. Kaplan-Meier and Cox proportional analyses indicated that patients positive by the biomarker panel (including those with cTnI ≤ 0.04 μg/l) had significantly worse outcomes (death/MI/HF) as compared to those negative by both cTnI and the panel test. Conclusion: A biomarker panel analyzed early after pain onset can identify individuals at risk for both myocardial necrosis and the combined endpoint of death/MI/HF. Additional prospective studies are required to assess this panel for both early MI detection and to further refine which health outcomes (death, MI, HF) are associated with positive panel results.
KW - Acute coronary syndrome
KW - Biomarker panel
KW - Myocardial necrosis
KW - Outcomes
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U2 - 10.1016/j.cca.2007.09.023
DO - 10.1016/j.cca.2007.09.023
M3 - Article
C2 - 17964560
AN - SCOPUS:35748934502
SN - 0009-8981
VL - 387
SP - 133
EP - 138
JO - Clinica Chimica Acta
JF - Clinica Chimica Acta
IS - 1-2
ER -