Assessment of multiple cardiac biomarkers in non-ST-segment elevation acute coronary syndromes: Observations from the MERLIN-TIMI 36 Trial

Benjamin M. Scirica, Marc S. Sabatine, Petr Jarolim, Sabina A. Murphy, James A de Lemos, Eugene Braunwald, David A. Morrow

Research output: Contribution to journalArticle

67 Scopus citations

Abstract

Aims The aim of this study is to simultaneously evaluate the incremental prognostic value of multiple cardiac biomarkers reflecting different underlying pathophysiological processes in a well-characterized population of patients with non-ST-segment acute coronary syndrome (NSTE-ACS).Methods and resultsWe measured cardiac troponin I (cTnI), N-terminal pro B-type natriuretic peptide (NT-proBNP), C-reactive protein, and myeloperodixase (MPO) among 4352 patients with NSTE-ACS in the MERLIN-TIMI 36 (Metabolic Efficiency With Ranolazine for Less Ischaemia in Non-ST Elevation Acute Coronary-Thrombolysis In Myocardial Infarction 36) trial and followed them for a mean of 343 days. When added individually to a multivariable model adjusted for clinical characteristics, the risk of cardiovascular (CV) death rose in a stepwise fashion with increasing quartiles of each biomarker, and when using their pre-defined cut-points [HRadj 2.71 (P < 0.001) for cTnI <0.03 ng/mL; HRadj 3.01 (P < 0.001) for NT-proBNP <400 pg/mL; HRadj 1.45 (P 0.019) for high-sensitivity (hs) C-reactive protein <15 mg/L; and HRadj 1.49 (P 0.006) for MPO <670 pmol/L]. After including all biomarkers, only NT-proBNP and cTnI were independently associated with CV death, and only cTnI with myocardial infarction (MI). The addition of NT-proBNP to a model adjusted for TIMI risk score incorporating cTnI significantly improved both the discrimination and re-classification of the model for CV death and heart failure (HF) while there was no such improvement after the addition of either MPO or hs-C-reactive protein.Conclusion In this study of over 4300 patients presenting with NSTEACS, we found that both cTnI and NT-proBNP offer prognostic information beyond that achieved with clinical risk variables for CV death, MI, and HF. Myeloperoxidase and hs-C-reactive protein, while independently associated with some adverse CV outcomes, did not provide substantial incremental prognostic information when evaluated together with cTnI and NT-proBNP.

Original languageEnglish (US)
Pages (from-to)697-705
Number of pages9
JournalEuropean heart journal
Volume32
Issue number6
DOIs
StatePublished - Mar 2011

Keywords

  • Acute coronary syndrome
  • Biomarkers
  • Myeloperoxidase
  • Natriuretic peptides
  • Risk-stratification
  • Troponin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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