Multimarker approach to risk stratification in non-ST elevation acute coronary syndromes - Simultaneous assessment of troponin I, C-reactive protein, and B-type natriuretic peptide
Multimarker approach to risk stratification in non-ST elevation acute coronary syndromes - Simultaneous assessment of troponin I, C-reactive protein, and B-type natriuretic peptide
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DOI：
10.1161/01.cir.0000015464.18023.0a
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发表时间：
2002-04-16
期刊：
影响因子：
37.8
通讯作者：
Braunwald, E
中科院分区：
文献类型：
--
作者：
Sabatine, MS;Morrow, DA;Braunwald, E
背景：在急性冠脉综合征（ACS）患者中，肌钙蛋白I （TnI）、c反应蛋白（CRP）和b型利钠肽（BNP）均可预测心脏不良事件。然而，人们对这些生物标志物联合使用的效用知之甚少。方法和结果：在OPUS-TIMI 16中，450例患者进行了TnI、CRP和BNP的基线测量。TnI、CRP和BNP的升高都是死亡、心肌梗死（MI）或充血性心力衰竭（CHF）的独立预测因子。当患者根据入院时升高的生物标志物数量进行分类时，每增加一个升高的生物标志物，死亡风险几乎增加一倍（P=0.01）。在30天和10个月内，MI、CHF和综合治疗的终点也存在类似的关系。在TACTICS-TIMI 18的1635例患者验证队列中，在对已知临床预测因子进行调整后，升高的生物标志物数量仍然是复合终点的重要预测因子：1、2和3种升高的生物标志物的患者分别为2.1- (P=0.006)和3.1- （P=0.006）
Background-In patients with acute coronary syndromes (ACS), troponin I (TnI), C-reactive protein (CRP), and B-type natriuretic peptide (BNP) each predict adverse cardiac events. Little is known, however, about the utility of these biomarkers in combination.Methods and Results-Base line measurements of TnI, CRP, and BNP were performed in 450 patients, in OPUS-TIMI 16. Elevations in TnI, CRP, and BNP each were independent predictors of the composite of death, myocardial infarction (MI), or congestive heart failure (CHF). When patients were categorized on the basis of the number of elevated biomarkers at presentation, there was a near doubling of the mortality risk for each additional biomarker that was elevated (P=0.01). Similar relationships existed for the endpoints of MI, CHF, and the composite, both at 30 days and through 10 months. In a validation cohort of 1635 patients in TACTICS-TIMI 18, the number of elevated biomarkers remained a significant predictor of the composite endpoint after adjustment for known clinical predictors: patients with one, two, and three elevated biomarkers had a 2.1- (P=0.006), 3.1- (P