Clinical Predictors of 30-day Cardiac Events in Patients with Acute Coronary Syndrome at a Community Hospital

Background: Growth differentiation factor (GDF)-15, a stress responsive cytokine, is associated with the risk of CV events after an acute coronary syndrome (ACS). Unlike other established cardiac biomarkers, the level of GDF-15 remains elevated in sub-acute phase after ACS and gradually decreases over time. We evaluated the prognostic utility of GDF-15 in patients after ACS accounting for established markers and risk predictors. Methods: GDF-15 (R&D Systems) and other established cardiac biomarkers (BNP, hsCRP and hsTnI) were measured at baseline in a randomly selected cohort of 4,968 patients enrolled within 30 days of hospitalization with ACS (median=14d) in SOLID-TIMI 52. Previously defined cutpoints were applied for GDF-15 concentration: <1200 (n=3451), 1200-1800 (n=919), and > 1800 ng/L (n=598). Analyses were adjusted for established risk predictors, days from the ACS event and other markers. MACE was defined as CV death, MI or stroke. Median follow-up was 2.5 years. Results: Patients with higher GDF-15 tended to be older, more likely to have diabetes, hypertension, history of revascularization, and CKD at baseline. Higher baseline levels of GDF-15 identified patients with higher rates of MACE as well as each individual element (p-trend <0.001 for all endpoints, Fig). The rate of MI was ∼2-fold higher in those with GDF-15 concentration >1800ng/L compared to patients with GDF-15 concentration <1200 ng/L. After adjustment for clinical predictors and other markers, GDF-15 was independently associated with the risk of MACE (HR 1.4, 95% CI 1.1-1.7; HR 1.8, 95% CI 1.4-2.3 for GDF-15 1200-1800, >1800, respectively). Individuals with GDF-15 >1800 ng/L had an increased risk of MI (adj HR 1.4, 95% CI 1.1-2.0) and stroke (adj HR 2.3, 95% CI 1.3-3.9). Conclusion: In patients after ACS, GDF-15 concentration is associated with the risk of MACE including MI and stroke independent of traditional risk factors and risk markers.

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DEMOGRAPHIC AND CLINICAL PREDICTORS OF ACUTE CORONARY SYNDROME IN PATIENTS WITH PREHOSPITAL CHEST PAIN AND BENIGN ECG FINDINGS

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2018.07.431 ◽

2018 ◽

Vol 34 (10) ◽

pp. S201-S202

Author(s):

S. Al-Zaiti ◽

Z. Faramand ◽

C. Martin-Gill ◽

C. Callaway

Keyword(s):

Acute Coronary Syndrome ◽

Chest Pain ◽

Clinical Predictors ◽

Coronary Syndrome

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Development of a Clinical Prediction Rule for 30-Day Cardiac Events in Emergency Department Patients With Chest Pain and Possible Acute Coronary Syndrome

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2011.07.026 ◽

2012 ◽

Vol 59 (2) ◽

pp. 115-125.e1 ◽

Cited By ~ 89

Author(s):

Erik P. Hess ◽

Robert J. Brison ◽

Jeffrey J. Perry ◽

Lisa A. Calder ◽

Venkatesh Thiruganasambandamoorthy ◽

...

Keyword(s):

Emergency Department ◽

Acute Coronary Syndrome ◽

Chest Pain ◽

Prediction Rule ◽

Clinical Prediction Rule ◽

Clinical Prediction ◽

Cardiac Events ◽

Coronary Syndrome ◽

Emergency Department Patients

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Abstract 2602: Elevated Serum Neopterin Levels and Adverse Cardiac Events in Patients with Non-ST-Segment Elevation Acute Coronary Syndrome

Circulation ◽

10.1161/circ.116.suppl_16.ii_576-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Juan Carlos Kaski ◽

Luciano Consuegra-Sanchez ◽

Daniel J. Fernandez-Berges ◽

Jose M Cruz-Fernandez ◽

Xavier Garcia-Moll ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Unstable Angina ◽

Elevated Serum ◽

Cardiac Events ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment ◽

Adverse Cardiac Events ◽

Elevation Acute Coronary Syndrome

Objectives: We sought to assess whether plasma neopterin predicts adverse clinical outcomes in patients with NSTEACS. Background: Circulating C reactive protein (CRP), a marker of inflammation, correlates with events in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). High neopterin levels - a marker of macrophage activation - predict cardiovascular events in stable angina patients but their prognostic role in NSTEACS has not been systematically evaluated. Methods: We prospectively assessed 397 patients (74 % men) admitted with NSTEACS: 169 (42.5%) had unstable angina and 228 (57.5%) non-ST-segment elevation myocardial infarction (NSTEMI). Blood samples for neopterin and CRP assessment were obtained at admission. TIMI risk score was also assessed among other clinical and biochemical variables. The study end point was the composite of cardiac death, acute myocardial infarction and recurrent angina at 180-days. Results: Baseline neopterin concentrations (nmol/L) were similar in unstable angina and NSTEMI patients (8.3 [6.5–10.6] vs 8.0 [6.2–11.1], p = 0.54). Fifty-nine patients (14.9 %) had events during follow-up (highest third (%) 21.5 vs 1 st and 2 nd thirds 11.5, log rank 7.341, p = 0.007). On multivariable hazard Cox regression, only neopterin (highest vs 1 st and 2 nd thirds, HR 2.15, 95 % CI [1.21–3.81]) was independently associated with the combined endpoint.CRP levels, however, were not significantly different in patients with events compared to those without events (adjusted HR = 0.98, p = 0.89, 95% CI 0.80 –1.21). Conclusion: Increased neopterin levels are an independent predictor of 180-day adverse cardiac events in patients with NSTEACS.

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