A multimarker risk stratification approach to non-ST elevation acute coronary syndrome: implications of troponin T, CRP, NT pro-BNP and fibrin D-dimer levels

Background: It is not yet investigated whether referral decisions based on prehospital risk stratification of non-ST-elevation Acute Coronary Syndrome (NSTE-ACS) by the complete History, ECG, Age, Risk factors and initial Troponin (HEART) score are feasible and safe. Hypothesis: Implementation of referral decisions based on the prehospital acquired HEART score in patients with suspected NSTE-ACS is feasible and not inferior to routine management in the occurrence of major adverse cardiac events within 45 days. Study design & methods: FamouS Triage 3 is a feasibility study with a before–after sequential design. The aim is to assess whether prehospital HEART-score management including point-of-care troponin measurement is feasible and noninferior to routine management. Primary end point is the occurrence of major adverse cardiac events within 45 days. Conclusion: If referral decisions based on prehospital acquired risk stratification are feasible and noninferior this can become the new prehospital management in suspected NSTE-ACS.

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474 IL-1RN (VNTR) gene polymorphism predicts clinical events up to 1 year a non-ST-elevation acute coronary syndrome: an association independent of troponin T and C-reactive protein

European Heart Journal ◽

10.1016/s0195-668x(03)93912-1 ◽

2003 ◽

Vol 24 (5) ◽

pp. 70

Author(s):

K RAY

Keyword(s):

Acute Coronary Syndrome ◽

Gene Polymorphism ◽

Troponin T ◽

C Reactive Protein ◽

Reactive Protein ◽

Coronary Syndrome ◽

Clinical Events ◽

St Elevation ◽

Elevation Acute Coronary Syndrome

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Prognostic benefit from an early invasive strategy in patients with non-ST elevation acute coronary syndrome (NSTEACS): evaluation of the new risk stratification in the NSTEACS European guidelines

Clinical Research in Cardiology ◽

10.1007/s00392-021-01829-8 ◽

2021 ◽

Author(s):

Jesús Martinón-Martínez ◽

Belén Álvarez Álvarez ◽

Teba González Ferrero ◽

Federico García-Rodeja Arias ◽

Óscar Otero García ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Risk Stratification ◽

Invasive Strategy ◽

Coronary Syndrome ◽

European Guidelines ◽

St Elevation ◽

Elevation Acute Coronary Syndrome ◽

Early Invasive Strategy

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Clinical scores and patient risk stratification in non-ST elevation acute coronary syndrome

International Journal of Cardiology ◽

10.1016/j.ijcard.2010.04.016 ◽

2011 ◽

Vol 146 (2) ◽

pp. 219-224 ◽

Cited By ~ 6

Author(s):

D. Fernández-Bergés ◽

V. Bertomeu-Gonzalez ◽

P.L. Sánchez ◽

J.M. Cruz-Fernandez ◽

R. Arroyo ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Risk Stratification ◽

Patient Risk ◽

Coronary Syndrome ◽

Clinical Scores ◽

St Elevation ◽

Elevation Acute Coronary Syndrome

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Biomarkers and Coronary Lesions Predict Outcomes after Revascularization in Non–ST-Elevation Acute Coronary Syndrome

Clinical Chemistry ◽

10.1373/clinchem.2016.261271 ◽

2017 ◽

Vol 63 (2) ◽

pp. 573-584 ◽

Cited By ~ 15

Author(s):

Daniel Lindholm ◽

Stefan K James ◽

Maria Bertilsson ◽

Richard C Becker ◽

Christopher P Cannon ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Troponin T ◽

Full Model ◽

Standard Deviation Increase ◽

Clinical Variables ◽

Coronary Syndrome ◽

End Point ◽

C Statistic ◽

St Elevation ◽

Elevation Acute Coronary Syndrome

Abstract BACKGROUND Risk stratification in non–ST-elevation acute coronary syndrome (NSTE-ACS) is currently mainly based on clinical characteristics. With routine invasive management, angiography findings and biomarkers are available and may improve prognostication. We aimed to assess if adding biomarkers [high-sensitivity cardiac troponin T (cTnT-hs), N-terminal probrain-type natriuretic peptide (NT-proBNP), growth differentiation factor 15 (GDF-15)] and extent of coronary artery disease (CAD) might improve prognostication in revascularized patients with NSTE-ACS. METHODS In the PLATO (Platelet Inhibition and Patient Outcomes) trial, 5174 NSTE-ACS patients underwent initial angiography and revascularization and had cTnT-hs, NT-proBNP, and GDF-15 measured. Cox models were developed adding extent of CAD and biomarker levels to established clinical risk variables for the composite of cardiovascular death (CVD)/spontaneous myocardial infarction (MI), and CVD alone. Models were compared using c-statistic and net reclassification improvement (NRI). RESULTS For the composite end point and CVD, prognostication improved when adding extent of CAD, NT-proBNP, and GDF-15 to clinical variables (c-statistic 0.685 and 0.805, respectively, for full model vs 0.649 and 0.760 for clinical model). cTnT-hs did not contribute to prognostication. In the full model (clinical variables, extent of CAD, all biomarkers), hazard ratios (95% CI) per standard deviation increase were for cTnT-hs 0.93(0.81–1.05), NT-proBNP 1.32(1.13–1.53), GDF-15 1.20(1.07–1.36) for the composite end point, driven by prediction of CVD by NT-proBNP and GDF-15. For spontaneous MI, there was an association with NT-proBNP or GDF-15, but not with cTnT-hs. CONCLUSIONS In revascularized patients with NSTE-ACS, the extent of CAD and concentrations of NT-proBNP and GDF-15 independently improve prognostication of CVD/spontaneous MI and CVD alone. This information may be useful for selection of patients who might benefit from more intense and/or prolonged antithrombotic treatment. ClinicalTrials.gov Identifier: NCT00391872

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Cystatin C for Enhancement of Risk Stratification in Non–ST Elevation Acute Coronary Syndrome Patients with an Increased Troponin T

Clinical Chemistry ◽

10.1373/clinchem.2008.119669 ◽

2009 ◽

Vol 55 (6) ◽

pp. 1118-1125 ◽

Cited By ~ 29

Author(s):

Fons Windhausen ◽

Alexander Hirsch ◽

Johan Fischer ◽

P Marc van der Zee ◽

Gerard T Sanders ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Renal Function ◽

Risk Stratification ◽

Cystatin C ◽

Treatment Strategy ◽

Troponin T ◽

Invasive Treatment ◽

Coronary Syndrome ◽

The Third ◽

St Elevation

Abstract Background: We assessed the value of cystatin C for improvement of risk stratification in patients with non–ST elevation acute coronary syndrome (nSTE-ACS) and increased cardiac troponin T (cTnT), and we compared the long-term effects of an early invasive treatment strategy (EIS) with a selective invasive treatment strategy (SIS) with regard to renal function. Methods: Patients (n = 1128) randomized to an EIS or an SIS in the ICTUS trial were stratified according to the tertiles of the cystatin C concentration at baseline. The end points were death within 4 years and spontaneous myocardial infarction (MI) within 3 years. Results: Mortality was 3.4%, 6.2%, and 13.5% in the first, second, and third tertiles, respectively, of cystatin C concentration (log-rank P < 0.001), and the respective rates of spontaneous MI were 5.5%, 7.5%, and 9.8% (log-rank P = 0.03). In a multivariate Cox regression analysis, the cystatin C concentration in the third quartile remained independently predictive of mortality [hazard ratio (HR), 2.04; 95% CI, 1.02–4.10; P = 0.04] and spontaneous MI (HR, 1.95; 95% CI, 1.05–3.63; P = 0.04). The mortality rate in the second tertile was lower with the EIS than with the SIS (3.8% vs 8.7%). In the third tertile, the mortality rates with the EIS and the SIS were, respectively, 15.0% and 12.2% (P for interaction = 0.04). Rates of spontaneous MI were similar for the EIS and the SIS within cystatin C tertiles (P for interaction = 0.22). Conclusions: In patients with nSTE-ACS and an increased cTnT concentration, mild to moderate renal dysfunction is associated with a higher risk of death and spontaneous MI. Use of cystatin C as a serum marker of renal function may improve risk stratification.

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