natriuretic-peptide--brain and Acute-Coronary-Syndrome

Diagnosis and prognostication in acute coronary syndromes (ACS) is achieved using a combination of clinical factors and biomarkers, notably cardiac troponin and B type natriuretic peptide and its N terminal fragment NT-proBNP. However, there are numerous biomarkers that have been shown to be associated with ACS, with variable incremental utility. This brief review focusses on some promising emerging biomarkers in ACS, discussed according to pathophysiologic mechanism, as well as diagnostic and prognostic utility.

Topics: Acute Coronary Syndrome; Biomarkers; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Risk Assessment

To assess the diagnostic value of B-type natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) for contrast-induced acute kidney injury (CI-AKI) in patients with acute coronary syndrome (ACS) undergoing coronary angiography.. ACS remains a major cause of death worldwide. Patients with ACS undergoing coronary angiography are more likely to develop CI-AKI, which correlates highly with poor clinical outcomes. Early diagnosis of CI-AKI remains a challenge. Many recent studies have suggested that BNP or NT-proBNP may be a useful biomarker for the early diagnosis of CI-AKI.. We searched databases (PubMed, EMBASE, and Cochrane Library) to identify eligible studies. Two authors independently screened the studies and extracted data. We used the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) criteria to assess the methodological quality of the included studies and STATA to perform all statistical analyses.. Nine studies including 2832 patients were identified. The pooled sensitivity of 0.73 (95% CI 0.65-0.79), specificity of 0.79 (95% CI 0.70-0.85), and area under the summary receiver operating characteristic curve of 0.81 (95% CI 0.77-0.84) suggested that BNP or NT-proBNP had a good diagnostic value for CI-AKI in patients with ACS undergoing coronary angiography.. Our findings suggest that BNP or NT-proBNP may be an effective predictive marker for CI-AKI. However, additional high-quality studies are required to find the optimal cutoff value and the diagnostic value of BNP or NT-proBNP in combination with other biomarkers.

Topics: Acute Coronary Syndrome; Acute Kidney Injury; Biomarkers; Coronary Angiography; Humans; Natriuretic Peptide, Brain; Predictive Value of Tests

Cardiovascular diseases (CVD) remain the leading cause of death within industrialized nations as well as an increasing cause of mortality and morbidity in many developing countries. Smoking, alcohol consumption and increased level of blood cholesterol are the main CVD risk factors. Other factors, such as the prevalence of overweight/obesity and diabetes, have increased considerably in recent decades and are indirect causes of CVD. Among CVDs, the acute coronary syndrome (ACS) represents the most common cause of emergency hospital admission. Since the prognosis of ACS is directly associated with timely initiation of revascularization, missed, misdiagnosis or late diagnosis have unfavorable medical implications. Early ACS diagnosis can reduce complications and risk of recurrence, finally decreasing the economic burden posed on the health care system as a whole. To decrease the risk of ACS and related CVDs and to reduce associated costs to healthcare systems, a fast management of patients with chest pain has become crucial and urgent. Despite great efforts, biochemical diagnostic approaches of CVDs remain difficult and controversial medical challenges as cardiac biomarkers should be rapidly released into the blood at the time of ischemia and persistent for a sufficient length of time to allow diagnostics, with tests that should be rapid, easy to perform and relatively inexpensive. Early biomarker assessments have involved testing for the total enzyme activity of aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and creatine kinase (CK), which cardiac troponins being the main accepted biomarkers for diagnosing myocardial injury and acute myocardial infarction (AMI). To allow rapid diagnosis, it is necessary to replace the traditional biochemical assays by cardiac biosensor platforms. Among the numerous of possibilities existing today, electrochemical biosensors are important players as they have many of the required characteristics for point-of-care tests. Electrochemical based cardiac biosensors are highly adapted for monitoring the onset and progress of cardiovascular diseases in a fast and accurate manner, while being cheap and scalable devices. This review outlines the state of the art in the development of cardiac electrochemical sensors for the detection of different cardiac biomarkers ranging from troponin to BNP, N-terminal proBNP, and others.

Topics: Acute Coronary Syndrome; Biomarkers; Biosensing Techniques; Cardiovascular Diseases; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Risk Factors; Troponin

Point-of-care tests (POCT) can assist general practitioners (GPs) in diagnosing and treating patients with acute cardiopulmonary symptoms, but it is currently unknown if POCT impact relevant clinical outcomes in these patients.. To assess whether using POCT in primary care patients with acute cardiopulmonary symptoms leads to more accurate diagnosis and impacts clinical management.. We performed a systematic review in four bibliographic databases. Articles published before February 2016 were screened by two reviewers. Studies evaluating the effect of GP use of POCT on clinical diagnostic accuracy and/or effect on treatment and referral rate in patients with cardiopulmonary symptoms were included.. Our search yielded nine papers describing data from seven studies, on the clinical diagnostic accuracy of POCT in a total of 2277 primary care patients with acute cardiopulmonary symptoms. Four papers showed data on GP use of D-dimer POCT in pulmonary embolism (two studies); two studies on Troponin T in acute coronary syndrome; one on heart-type fatty acid-binding protein (H-FABP) in acute coronary syndrome; one on B-type natriuretic peptide (BNP) in heart failure; one on 3-in-1 POCT (Troponin T, BNP, D-dimer) in acute coronary syndrome, heart failure and/or pulmonary embolism. Only one study assessed the effect of GP use of POCT on treatment initiation and one on actual referral rates.. There is currently limited and inconclusive evidence that actual GP use of POCT in primary care patients with acute cardiopulmonary symptoms leads to more accurate diagnosis and affects clinical management. However, some studies show promising results, especially when a POCT is combined with a clinical decision rule.

Topics: Acute Coronary Syndrome; Acute Disease; Biomarkers; Fibrin Fibrinogen Degradation Products; Heart Failure; Humans; Natriuretic Peptide, Brain; Point-of-Care Testing; Primary Health Care; Pulmonary Embolism; Randomized Controlled Trials as Topic; Troponin T

Cardiac troponin (cTn) plays an essential role for assessment of outcome in acute coronary syndrome (ACS). However, the prognostic value of cTn is not absolute. In this mini-review, we summarize the evidence on the utility of established biomarkers of left-ventricular dysfunction, hemodynamic stress, inflammation, and renal dysfunction for risk prediction beyond cTn in ACS.. Only few biomarkers consistently demonstrate additive prognostic value to cTn levels. The B-type natriuretic peptides (NPs) and growth-differentiation factor-15 (GDF-15) are most promising in this regard. However, there are uncertainties regarding the role of these biomarkers for guidance of treatment decisions, and their prognostic increment to cTn levels measured with high-sensitivity assays is largely unknown. The NPs and GDF-15 provide the strongest prognostic increment to cTn levels in ACS. However, the role of these biomarkers for clinical decision-making in contemporary settings has still to be defined.

Topics: Acute Coronary Syndrome; Biomarkers; Growth Differentiation Factor 15; Humans; Inflammation; Kidney Diseases; Myocardial Infarction; Natriuretic Peptide, Brain; Prognosis; Troponin; Ventricular Dysfunction, Left

Acute coronary syndrome (ACS), especially myocardial infarction, commonly known as a heart attack, is a serious life-threatening cardiovascular disease. Despite dramatic therapeutic advances, there have still been more than 20% patients with ACS suffering recurrent adverse cardiovascular events 3 years after disease onset. Therefore, the aim to prevent cardiac death caused by the heart attack remains challenging. Plasma biomarkers, originally developed to complement clinical assessment and electrocardiographic examination for the diagnosis of ACS, have been reported to play important prognostic roles in predicting adverse outcomes. These biomarkers mirror different pathophysiological mechanisms in association with ACS. In this review, we focus on advances of prognostic biomarkers in the past decade for short- and long-term risk assessment and management of patients with ACS.

Topics: Acute Coronary Syndrome; Adrenomedullin; Biomarkers; Chemokines; Cytokines; Fatty Acid-Binding Proteins; Glycopeptides; Humans; MicroRNAs; Natriuretic Peptide, Brain; Prognosis; Troponin; Vascular Endothelial Growth Factor B

Several observational studies evaluated the associations of baseline N-terminal pro-brain natriuretic peptide (NT-proBNP) and new-onset atrial fibrillation (AF) in patients with acute coronary syndrome (ACS), but the results were contradictory.. Electronic bibliographic databases were searched from inception to May 2015, and the results reviewed by two independent reviewers. Pooled standardized mean difference (SMD) and 95% confidence interval (CI) were calculated to assess associations between NT-proBNP levels and new-onset AF in patients with ACS. We performed sensitivity analyses to explore the potential sources of heterogeneity and estimated publication biases.. Six papers, including 5861 patients (438 with AF and 5423 without AF) with ACS were analyzed. Overall, the NT-proBNP levels were higher in patients with new-onset AF than controls without AF. The SMD of the NT-proBNP levels between the patients with and those without AF was 0.53 units (95% CI 0.37-0.70), test for overall effect z-score =6.30 (p < 0.00001). The heterogeneity test showed that there were moderate differences between individual studies (p = 0.02; I(2) =( )62%). Further analysis revealed that differences of ethnic groups and the sample size of studies possibly account for this heterogeneity.. In spite of moderate heterogeneity across the enrolled studies, our meta-analysis suggests that increased NT-proBNP levels are associated with greater risk of new-onset AF with ACS, which indicates that NT-proBNP levels may be a useful biomarker in predicting new-onset AF in patients with ACS.

Topics: Acute Coronary Syndrome; Atrial Fibrillation; Biomarkers; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Risk

To systematically evaluate the efficacy and safety of Danhong injection (DH) in treating acute coronary syndrome (ACS), randomized controlled trials (RCTs) regarding ACS treated by DH were searched in Chinese and English electronic databases from inception until June 2013. Two reviewers independently retrieved RCTs and extracted information. The Cochrane risk of bias method was used to assess the quality of the included studies, and a meta-analysis was conducted with Review Manager 5.2 software. About 26 RCTs with 2660 participants were included. The methodological quality was usually not high, and only one study used a randomized, double-blinded method. The meta-analysis indicated that on the basis of conventional therapy with Western medicine (WM), DH was more effective in increasing the total effective rate [RR = 1.24, 95%CI (1.17, 1.32), p < 0.00001]. Additionally, DH can decrease inflammatory cytokines, including high sensitive C-reactive protein (Hs-CRP) and interleukin-6 (IL-6), lower plasma viscosity, plasma endothelin-1 (ET-1) and brain natriuretic peptide (BNP), reduce the generation of myeloperoxidase (MPO), and decrease the number of T-wave inversion. There were no adverse drug reactions (ADR) reported in the experimental group, while one case occurred in the control group. Based on the systematic review, DH combined with WM was effective in the treatment of ACS. However, the safety of DH in the treatment of ACS should be further carefully interpreted by more large-scale and double-blind RCTs.

Topics: Acute Coronary Syndrome; Blood Viscosity; C-Reactive Protein; Databases, Bibliographic; Double-Blind Method; Drugs, Chinese Herbal; Endothelin-1; Humans; Inflammation Mediators; Injections; Interleukin-6; Natriuretic Peptide, Brain; Peroxidase; Randomized Controlled Trials as Topic; Treatment Outcome

Biomarkers are well established for diagnosis of myocardial infarction [cardiac troponins, high-sensitivity cardiac troponins (hs-cTn)], exclusion of acute and chronic heart failure [B-type natriuretic peptide (BNP), N-terminal proBNP (NT-proBNP)] and venous thromboembolism (d-dimers). Several studies have demonstrated acute increases in cardiac biomarkers and altered cardiac function after strenuous sports that can pretend a cardiovascular emergency and interfere with state-of-the-art clinical assessment.. We performed a systematic review and metaanalysis of biomarker and cardiovascular imaging changes after endurance exercise. We searched for observational studies published in the English language from 1997 to 2014 that assessed these biomarkers or cardiac function and morphology directly after endurance exercise. Of 1787 identified abstracts, 45 studies were included.. Across all studies cardiac troponin T (cTnT) exceeded the cutoff value (0.01 ng/mL) in 51% (95% CI, 37%-64%) of participants. The measured pooled changes from baseline for high-sensitivity cTnT (hs-cTnT) were +26 ng/L (95% CI, 5.2-46.0), for cTnI +40 ng/L (95% CI, 21.4; 58.0), for BNP +10 ng/L (95% CI, 4.3; 16.6), for NT-proBNP +67 ng/L (95% CI, 49.9; 84.7), and for d-dimer +262 ng/mL (95% CI, 165.9; 358.7). Right ventricular end diastolic diameter increased and right ventricular ejection fraction as well as the ratio of the early to late transmitral flow velocities decreased after exercise, while no significant changes were observed in left ventricular ejection fraction.. Current cardiovascular biomarkers (cTnT, hs-cTnT, BNP, NT-proBNP, and d-dimer) that are used in clinical diagnosis of pulmonary embolism, acute coronary syndrome, and heart failure are prone to alterations due to strenuous exercise. Hence, it is necessary to take previous physical exercise into account when a cardiac emergency is suspected.

Topics: Acute Coronary Syndrome; Biomarkers; Exercise Test; Exercise Tolerance; Fibrin Fibrinogen Degradation Products; Heart Failure; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Pulmonary Embolism; Troponin T

B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are the gold standard biomarkers in determining heart failure (HF) diagnosis and prognosis. These natriuretic peptides may also be useful in guiding HF management, but further studies are needed before they can be routinely recommended for that purpose. A novel natriuretic peptide biomarker, mid-regional pro atrial natriuretic peptide (MR-proANP), shows promise in determining diagnosis and prognosis in HF patients. BNP and NT-proBNP may be of use in excluding myocardial infarction and to assist in determining prognosis in acute coronary syndrome (ACS). Therapeutic implication of natriuretic peptides in ACS is unclear.

Topics: Acute Coronary Syndrome; Atrial Natriuretic Factor; Heart Failure; Humans; Natriuretic Peptide, Brain; Natriuretic Peptides; Peptide Fragments; Prognosis

Very few studies have evaluated the potential of using B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) as surrogate markers to guide clinical interventional or conservative therapy decisions.. : The aim of the current study was to evaluate the potential of using BNP and NT-proBNP as surrogate markers to guide clinical interventional or conservative therapy decisions.. We identified randomized controlled trials that randomized patients with acute coronary syndrome (ACS) of unstable angina and myocardial infarction without ST-segment elevation ACS to early invasive therapy versus a more conservative approach by systematic search of articles and databases.. Five randomized controlled trials with a total of 8125 patients and with a mean duration of 11.2 months were included in the meta-analysis. At a mean follow-up of 11.2 months, the incidence of all-cause mortality was 5.9% in the early invasive group, compared with 6.8% in the conservative group (risk ratio = 0.74; 95% confidence interval, 0.59-0.86; P = 0.001).. In summary, BNP/NT-proBNP-guided management of ACS is significantly improved by early invasive therapy by improving long-term survival and reducing nonfatal myocardial infarction for unstable angina. However, there does not seem to be a clear benefit of using such a strategy over existing clinical recommendations.

Topics: Acute Coronary Syndrome; Biomarkers; Follow-Up Studies; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Randomized Controlled Trials as Topic

Topics: Acute Coronary Syndrome; Acute Disease; Atrial Natriuretic Factor; Biomarkers; Critical Care; Dyspnea; Heart Diseases; Heart Failure; Humans; Immunoassay; Natriuretic Peptide, Brain; Practice Guidelines as Topic; Pulmonary Embolism; Reference Values; Risk Assessment

Novel biomarkers of myocardial ischemia and inflammatory processes have the potential to improve diagnostic accuracy of acute coronary syndrome (ACS) within a shorter time interval after symptom onset.. The objective was to review the recent literature and evaluate the evidence for use of novel biomarkers in diagnosing ACS in patients presenting with chest pain or symptoms suggestive of cardiac ischemia to the emergency department or chest pain unit.. A literature search was performed in MEDLINE, EMBASE, Cochrane DSR, ACP Journal Club, DARE, CCTR, CMR, HTA, and NHSEED for studies from 2004 to 2010. We used the inclusion criteria: (1) human subjects, (2) peer-reviewed articles, (3) enrolled patients with ACS, acute myocardial infarction or undifferentiated signs and symptoms suggestive of ACS, and (4) English language or translated manuscripts. Two reviewers conducted a hierarchical selection and assessment using a scale developed by the International Liaison Committee on Resuscitation.. Out of a total 3194 citations, 58 articles evaluating 37 novel biomarkers were included for final review. Forty-one studies did not support the use of their respective biomarkers. Seventeen studies supported the use of 5 biomarkers, particularly when combined with cardiac-specific troponin: heart fatty acid-binding protein, ischemia-modified albumin, B-type natriuretic peptide, copeptin, and matrix metalloproteinase-9.. In patients presenting to the emergency department with chest pain or symptoms suggestive of cardiac ischemia, there is inadequate evidence to suggest the routine testing of novel biomarkers in isolation. However, several novel biomarkers have the potential to improve the sensitivity of diagnosing ACS when combined with cardiac-specific troponin.

Topics: Acute Coronary Syndrome; Biomarkers; Emergency Service, Hospital; Fatty Acid-Binding Proteins; Glycopeptides; Humans; Matrix Metalloproteinase 9; Myocardial Ischemia; Natriuretic Peptide, Brain; Serum Albumin; Serum Albumin, Human

Precise risk stratification is important in patients with non-ST elevation acute coronary syndromes (NSTE-ACS) on determination for hospitalization and intensity of treatment. A meta-analysis was performed in studies of patients with NSTE-ACS to evaluate the predictive nature of elevated N-terminal pro-brain natriuretic peptide (NT-proBNP).. Online searches were conducted using database to identify suitable studies. A summary of relative risks (RRs) for death and myocardial infarction (MI) was calculated using random-effects modeling. We also calculated the pooled sensitivity, specificity, positive predictive value, and negative predictive value.. Thirteen studies were included. Elevated NT-proBNP levels were significantly associated with mortality [RR 4.89; 95% confidence interval (CI) 3.85–6.22] and incidence of MI (RR 1.66; 95% CI 1.24–2.22). The sensitivity and specificity for MI was 69.1% (95% CI 66.6%–71.6%) and 43.6% (95% CI 42.9%–44.3%), respectively, along with the positive and negative predictive values for MI of 8.2% (95% CI 7.7%–8.7%) and 95.1% (95% CI 94.6%–95.5%), respectively.. Meta-analysis suggests that elevated NT-proBNP levels were associated with an increased risk for MI or death in patients with NSTE-ACS. Normal levels of NT-proBNP are certainly more helpful when selecting NSTE-ACS patients with likelihood for favorable outcomes.

Topics: Acute Coronary Syndrome; Aged; Electrocardiography; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis

Circulating biomarkers have become increasingly important in diagnosing and risk-stratifying patients with heart failure (HF). While the natriuretic peptides have received much focus in the past decade, there is increasing interest in the role of other circulating biomarkers such as mid-regional proadrenomedullin (MR-proADM), a stable peptide of the precursor of adrenomedullin (ADM), responsible for volume regulation and electrolyte homeostasis. Increased levels of MR-proADM are associated with an increased risk of mortality and morbidity in patients with HF, independent of natriuretic peptides. MR-proADM outperforms all other established markers in the identification of patients at highest risk of death, particularly death within 30 days. The prognostic superiority has consistently been shown for various cardiovascular disease states, including acute heart failure. In this article, we discuss the potential role of MR-proADM in the syndrome of acute heart failure and its implication on prognosis and risk stratification.

Topics: Acute Coronary Syndrome; Acute Disease; Adrenomedullin; Biomarkers; Chronic Disease; Endothelium, Vascular; Heart Failure; Humans; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Protein Precursors; Vasodilation

B-type natriuretic peptide (BNP) and N-terminal-proBNP (NT-proBNP) are increasingly recognized as prognostic markers in patients with acute coronary syndrome (ACS). The need for novel and more effective tools for risk assessment cannot be more emphasized than in older patients with ACS given their atypical presentation, multiple comorbidities, and higher risk for mortality and morbidity. Accurate interpretation of B-type NP values in older patients with ACS, however, may be confounded by several aging-related physiologic changes. Advanced age, reduction in body mass, and kidney function and anemia have been associated with higher BNP and NT-proBNP concentrations, and may create challenges with interpreting NP levels in the elderly. This review highlights the need to better understand the physiology of BNP and NT-proBNP in older individuals and their prognostic value in older patients with ACS.

Topics: Acute Coronary Syndrome; Age Factors; Aging; Biomarkers; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Risk Assessment; Risk Factors

Heart disease affects 1 in 3 individuals in the United States, and the prevalence of heart failure (HF) is increasing exponentially. Although our understanding of the disease progression of congestive HF (CHF) has advanced, refining the areas of diagnosis, risk stratification, prognosis, and treatment is still needed. The natriuretic peptides, specifically B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), have shown promise in clinical practice. Brain natriuretic peptide is released from cardiac ventricular myocytes in response to volume or pressure overload. Rapid measurement of plasma BNP or NT-proBNP has been shown to increase the diagnostic accuracy of HF exacerbations. A cutoff value of 100 pg/mL has a sensitivity and specificity of 90% and 73%, respectively, according to the Breathing Not Properly Study. In addition, BNP and NT-proBNP have been considered independent predictors of adverse outcome. One study calculated a 35% increase in risk of death due to HF for every 100-pg/mL increase in BNP level. Lastly, natriuretic peptides have been known to decrease following medical therapy of HF, suggesting the role of their measurement in monitoring inpatient disease progression and outpatient medical programs. The future of natriuretic peptides lies in risk stratification in other cardiac diseases, such as acute coronary syndrome, and possibly determining severity of valvular disease. Although there is substantial work done in elucidating the power of natriuretic peptides in clinical practice, more research is necessary to reach a consensus regarding how to appropriately utilize them in treatment regimens.

Topics: Acute Coronary Syndrome; Biomarkers; Cardiovascular Agents; Heart Failure; Heart Valve Diseases; Humans; Mass Screening; Monitoring, Physiologic; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Risk Assessment; Sensitivity and Specificity

Early recognition is indispensable for the optimal management of Acute Coronary Syndrome (ACS); moreover, early prognostic stratification of patients with established ACS is useful to improve strategies for these patients. The paper focuses attention on troponins (I and T), the most validated biomarker for early diagnosis of ACS and on B-type natriuretic peptide (BNP) and N-terminal proB-type natriuretic peptide (NT-proBNP), the most powerful cardiac marker after troponin to be used as prognostic indicator in patients with ACS. We pay particular attention to the troponin story in ACS, including discussions about high sensitivity methods and on the most recent techniques (e.g. Point Of Care) available to shorten times from the blood sampling to the validated report [Turn around time (TAT) arm-to-report]. We report the differences between BNP and NT-proBNP, both from an analytical and a clinical point of view and discuss the use of cardiac natriuretic peptides for early recognition of cardiac insufficiency and early management of patients presenting to Emergency Departments with dyspnoea. Finally, we briefly discuss the most promising new cardiac markers actually used only in preclinical studies.

Topics: Acute Coronary Syndrome; Animals; Biomarkers; Humans; Natriuretic Peptide, Brain; Troponin

Over the past decade, an evidence base has accumulated to support natriuretic peptide (NP) testing for diagnosis, risk assessment, and therapeutic monitoring and guidance of patients with heart failure. Investigators have also explored multiple other potential uses for these tests, including risk assessment of patients with suspected acute coronary syndromes (ACS). This article discusses the utility of NPs in the diagnosis and management of patients with ACS.

Topics: Acute Coronary Syndrome; Biomarkers; Evidence-Based Medicine; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Risk Assessment; Risk Factors; Treatment Outcome

The role of cardiac biomarkers in the diagnosis, risk stratification, and treatment of patients with chest pain and suspected acute coronary syndromes (ACS) has continued to evolve. Although it is clear that troponin (Tn) measurement provides independent prognostic information in patients with suspected ACS, it is less well established that early B-type natriuretic peptide (BNP) measurement provides additional incremental prognostic information above and beyond electrocardiography and Tn measurement. It is useful to identify patients at high risk for adverse events through measurement of Tn and BNP levels so that timely treatment decisions can be made.

Topics: Acute Coronary Syndrome; Biomarkers; Chest Pain; Hospital Mortality; Humans; Natriuretic Peptide, Brain; Predictive Value of Tests; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Troponin

Measurable B-type natriuretic peptides (BNPs), which are largely produced by the left ventricle, include BNP and N-terminal prohormone BNP (NT-proBNP). These proteins are released by cardiomyocytes in response to wall tension and neurohumoral signals, and are established tools in the diagnosis and prognosis of heart failure (HF). We identified 32 articles for entry into evidence tables that presented original data on BNP and/or NT-proBNP in more than 100 patients with acute coronary syndromes (ACS) presenting with chest discomfort with or without dyspnea. Natriuretic peptide (NP) elevation was associated with older age, female sex, hypertension, diabetes, prior HF, prior ischemic heart disease, and reduced renal function. Clinical correlates of elevated blood NP levels included left main or 3-vessel coronary disease, lipid-rich plaques with large necrotic cores in proximal locations, large zones of myocardial ischemia or infarction, no-reflow and impaired perfusion after percutaneous intervention, reduced left ventricular ejection fraction, higher Killip classification, and the development of cardiogenic shock. All studies indicated that after adjustment for baseline predictors and clinical risk scores, elevated NP concentrations were independently predictive of the development of HF and all-cause mortality. In contrast, studies did not consistently demonstrate that NPs were predictive of myocardial infarction and rehospitalization for ACS. In addition to baseline measurement, there is consensus that repeat testing at 4 to 12 weeks and 6 to 12 months in follow-up is helpful in the anticipation of late cardiac sequelae and may assist in assessing prognosis and guiding management.

Topics: Acute Coronary Syndrome; Algorithms; Biomarkers; Chest Pain; Critical Pathways; Dyspnea; Evidence-Based Medicine; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Practice Guidelines as Topic; Predictive Value of Tests; Prognosis; Risk Assessment; Risk Factors; Up-Regulation

The production and release of natriuretic peptides (NPs) into the bloodstream are stimulated by increased left ventricular wall tension during volume overload. In ischemia, NPs are secreted by myocardial cells in response to stress or overload, particularly in the development of myocardial systolic dysfunction. The review details the time course of changes in amino acid N-terminal proBNP in acute coronary syndrome (ACS) with and without ST-segment elevation and discusses the role of the index in defining the tactics of treatment and prognosis in patients with ACS.

Topics: Acute Coronary Syndrome; Atrial Natriuretic Factor; Humans; Natriuretic Peptide, Brain; Predictive Value of Tests; Prognosis

Diagnosis of acute coronary syndrome (ACS) encompasses a wide spectrum of myocardial ischaemia varying from assuredly benign to potentially fatal. Cardiac biomarkers have had a major impact on the management of this disease and are now the cornerstone in its diagnosis and prognosis. In this review we discuss both the established and the newer emerging biomarkers in ACS and their role in highlighting not only myocardial necrosis but also different facets of the pathophysiology of ACS. The future of cardiac biomarker testing may be in multimarker testing to better characterize each patient of ACS and thus tailor both short-term and long-term therapy accordingly. This novel concept, however, needs to be tested in clinical trials for its incremental value and cost-effectiveness.

Topics: Acute Coronary Syndrome; Biomarkers; C-Reactive Protein; Cystatin C; Humans; Natriuretic Peptide, Brain; Precision Medicine; Risk Assessment; Troponin

Acute coronary syndromes (ACS) encompasses a spectrum of coronary heart diseases, ranging in severity from unstable angina to ST-elevation myocardial infarction (STEMI). Early diagnosis and risk stratification are needed in order to address correctly hospitalization and treatment. Although the diagnosis of STEMI in the presence of typical electrocardiogram (ECG) changes and symptoms is easy and does not require the use of biomarkers, cardiac biomarkers are particularly important in the Emergency Department (ED), where about 25% of patients admitted are affected by ACS but clinical presentation is often atypical and ECG alterations may be absent. The ideal marker in the ED should have rapid release, high sensitivity and specificity and risk stratifying properties. Classic cardiac biomarkers, like myoglobin, cardiac troponin T or I and creatine kinase-MB, have a poor sensitivity, dependent on the time past from the onset of symptoms to presentation, the duration of ischemia and the amount of myocardial tissue involved. Although the serial testing of these cardiac biomarkers can improve the detection of myocardial necrosis, there is still a need for the development of early markers that can reliably rule out ACS from the ED at presentation and also detect myocardial ischemia in the absence of irreversible myocyte injury. There are several markers which represent the different features of ACS pathogenesis and that can be divided into three major groups: markers of cardiac ischemia and necrosis, markers of inflammation and coronary plaque instability and marker of cardiac function.

Topics: Acute Coronary Syndrome; Albumins; Biomarkers; C-Reactive Protein; CD40 Ligand; Emergencies; Emergency Service, Hospital; Fatty Acid-Binding Proteins; Fatty Acids, Nonesterified; Humans; Natriuretic Peptide, Brain; Peroxidase; Pregnancy-Associated Plasma Protein-A

Signs of myocardial involvement are common in patients with acute cerebrovascular events. ST segment deviations, abnormal left ventricular function, increased N-terminal pro-brain natriuretic peptide (NT-proBNP), prolonged QT interval, and/or raised troponins are observed in up to one third of the patients. The huge majority of these findings are fully reversible. The changes may mimic myocardial infarction, but are not necessarily identical to coronary thrombosis. Based on the literature these signs may represent an acute catecholamine release provoked by the cerebrovascular catastrophe itself and not coronary thrombosis. However, all patients with signs of cardiac involvement during acute cerebrovascular events should receive a cardiological follow-up in order to exclude concomitant ischemic heart disease.

Topics: Acute Coronary Syndrome; Catecholamines; Heart; Humans; Myocardial Infarction; Myocardium; Natriuretic Peptide, Brain; Peptide Fragments; Stress, Psychological; Stroke; Troponin; Ventricular Dysfunction, Left

Myocardial infarction (MI) as an acute and life-threatening complication of coronary heart disease is one of the most frequent causes of death in Germany. Therefore, diagnosis, risk stratification and treatment of acute MI are of great clinical relevance. Specific recommendations concerning diagnosis of acute MI can be found in current guidelines of the European Society of Cardiology (ESC) and the German Cardiac Society, as well as in a consensus document "Universal definition of myocardial infarction", which has been published at the end of 2007. Here, cardiac markers, namely cardiac troponins, play a central role as a criterion for the diagnosis of myocardial infarction. Moreover, cardiac troponins provide prognostic information and are of great value for risk stratification of patients. Measurement of creatine kinase CK-MB is an alternative to troponin measurement, but is only recommended, if troponins are not available. As a cutoff value for cardiac biomarkers the 99th percentile of a healthy reference population has been defined. However, assays that are used for routine testing require adequate precision. Besides established biomarkers, several novel markers have been evaluated in clinical studies in recent years. Especially B-type natriuretic peptides (BNP and NT-proBNP) and C-reactive protein (CRP) have gained great interest and sufficient data has been gathered, justifying clinical application of these novel markers. As a consequence, BNP/NT-proBNP and CRP are mentioned in the current guidelines of the ESC as appropriate biomarkers for risk stratification. The clinical relevance of other novel biomarkers remains uncertain and necessitates further studies.

Topics: Acute Coronary Syndrome; Biomarkers; C-Reactive Protein; Germany; Humans; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Practice Guidelines as Topic; Predictive Value of Tests; Prognosis; Troponin

Circulating concentrations of B-type natriuretic peptide (BNP) and the N-terminal fragment (NT) of its prohormone (proBNP) are related to cardiac function and have emerged as clinically useful tools for the diagnosis of heart failure and for the estimation of prognosis in patients with heart failure and acute coronary syndromes. Recent studies have also convincingly documented that both BNP and NT-proBNP are powerful, independent prognostic indicators in patients with stable coronary artery disease. The associations are strongest for the end-points of death and heart failure, whereas the association with cardiac ischemic events is weaker or nonexistent, after adjustment for confounding factors. Importantly, BNP and NT-proBNP appear to provide incremental prognostic information to conventional risk factors, including markers of ventricular function and ischemia. Data documenting that BNP or NT-proBNP measurements can be used to guide treatment decisions in patients with stable coronary artery disease are still lacking.

Topics: Acute Coronary Syndrome; Biomarkers; Coronary Artery Disease; Heart Failure; Humans; Natriuretic Peptide, Brain; Predictive Value of Tests; Prognosis; Protein Precursors; Risk Factors

Acute coronary syndromes (ACS) are due to the rupture or erosion of atheromatous plaques. This produces, depending on plaque size, vascular anatomy and degree of collateral circulation, progressive tissue ischaemia which may progress to cardiomyocyte necrosis and subsequent cardiac remodelling. Cardiac biomarkers can be used for diagnosis and assessment of all of these stages. Markers to detect myocardial ischaemia at the pre-infarction stage are potentially the most interesting but also the most challenging. An ischaemia marker offers the opportunity to intervene to prevent progression to infarction. The challenges with potential ischaemia markers are specificity and the diagnostic reference standard for assessment. To date, only one, ischaemia modified albumin, has reached the point where clinical studies can be performed. The measurement of the cardiac troponins, cardiac troponin T and cardiac troponin I, has become the diagnostic standard as the biomarker of myocardial necrosis. The sensitive nature of troponin measurement has also revealed that myocardial necrosis is also found in a range of other clinical situations. This illustrates the need to use all clinical information for diagnosis of acute myocardial infarction. The measurement of B type natriuretic peptides can be shown to be diagnostic and prognostic for both acute ACS and detecting the sequelae of post infarction myocardial insufficiency. The role of the B type natriuretic peptides in detection of cardiac failure, acute and chronic, is well defined. Their role in ACS remains the subject of further studies.

Topics: Acute Coronary Syndrome; Acute Disease; Biomarkers; Cardiovascular Diseases; Chest Pain; Humans; Myocardial Infarction; Myocardial Ischemia; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Risk Assessment; Troponin I; Troponin T

Brain natriuretic peptides (BNP and pro-BNP) represent useful biomarkers in heart failure diagnosis and risk stratification; more recently their clinical use has been applied to acute coronary syndrome with and without ST segment elevation. Few studies have demonstrated that hormone dosage can add clinical and prognostic information with respect to the traditional laboratory analysis (i.e. troponin, MB-creatine-kinase, C-reactive protein). Besides these traditional biomarkers, growing data indicate potential laboratory indexes that can predict endothelial dysfunction, vascular thrombosis and platelet aggregation. However, their prognostic value is currently unknown. We describe the most widely used laboratory tools in coronary artery disease with potential prognostic power that could provide incremental predictive information in clinical practice.

Topics: Acute Coronary Syndrome; Angina Pectoris; Biomarkers; C-Reactive Protein; Coronary Artery Disease; Coronary Disease; Electrocardiography; Humans; Metalloproteins; Natriuretic Agents; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Risk Assessment; Sensitivity and Specificity; Troponin

Atherosclerosis is now widely accepted as an active process involving a pathological vascular triad of vascular cellular activation, inflammation, and thrombosis. Several biomarkers show promise for risk prediction in high risk patients in large scale studies. Some are modified by statin therapy and may be targets for future therapeutic drug development whereas others identify high risk groups that benefit from specific treatments such as intensive statin therapy. Further understanding the role of different biomarkers will help better understand the pathophysiology of ACS as well as provide personalized medical care.

Topics: 1-Alkyl-2-acetylglycerophosphocholine Esterase; Acute Coronary Syndrome; Biomarkers; C-Reactive Protein; CD40 Ligand; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Intercellular Adhesion Molecule-1; Natriuretic Peptide, Brain; Neopterin

Natriuretic peptide (NPs) levels have achieved worldwide acceptance. They are excellent rule-in and rule-out biomarkers for patients presenting with dyspnea. In the hospital, NP levels may represent altered forms of B-type natriuretic peptide (BNP), including the inactive precursor molecule, pro-BNP. NP levels drop during hospitalization as the patient is decongested. In the future, NP levels may be used as a surrogate to titrate outpatient therapy.

Topics: Acute Coronary Syndrome; Acute Disease; Algorithms; Biomarkers; Dyspnea; Heart Failure; Humans; Kidney Diseases, Cystic; Monitoring, Ambulatory; Natriuretic Peptide, Brain; Natriuretic Peptides; Obesity; Peptide Fragments; Prognosis; Pulmonary Edema; Pulmonary Embolism

Natriuretic peptides (BNP and pro-BNP) represent useful biomarkers in heart failure diagnosis and risk stratification, more recently their clinical use has been applied in Acute Coronary Syndrome (ACS) with and without ST elevation. Few studies demonstrated that hormones dosage could add clinical and prognostic information respect to the traditional laboratory analysis (i.e. Troponin, MB-creatinkinase, C-reactive protein). In fact, natriuretic peptides appear able to predict left ventricular enlargement and dysfunction after coronary episode and high plasma levels seem related to future cardiac events and poor prognosis at early and late time. Therefore, data from both experimental and clinical studies suggest that BNP and pro-BNP levels may reflect the size and severity of the ischemic insult, even in the absence of myocardial necrosis. On the basis of these reports, we describe below the potential clinical application and prognostic information of natriuretic peptides in patients affected to non-ST elevation coronary disease. Some recent patents discuss the role of cardiac hormones, especially focus on natriuretic peptide for the treatment of acute coronary syndrome.

Topics: Acute Coronary Syndrome; Angina Pectoris; Coronary Angiography; Coronary Disease; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis

To use protein biomarkers to identify people with type 2 diabetes at high risk of cardiovascular outcomes and death.. Biobanked serum from 4,957 ELIXA (Evaluation of Lixisenatide in Acute Coronary Syndrome) trial participants was analyzed. Forward-selection Cox models identified independent protein risk factors for major adverse cardiovascular events (MACE) and death that were compared with a previously validated biomarker panel.. NT-proBNP and osteoprotegerin predicted both outcomes. In addition, trefoil factor 3 predicted MACE, and angiopoietin-2 predicted death (C = 0.70 and 0.79, respectively, compared with 0.63 and 0.66 for clinical variables alone). These proteins had all previously been identified and validated. Notably, C statistics for just NT-proBNP plus clinical risk factors were 0.69 and 0.78 for MACE and death, respectively.. NT-proBNP and other proteins independently predict cardiovascular outcomes in people with type 2 diabetes following acute coronary syndrome. Adding other biomarkers only marginally increased NT-proBNP's prognostic value.

Topics: Acute Coronary Syndrome; Biomarkers; Diabetes Mellitus, Type 2; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Risk Assessment; Risk Factors

In patients with acute coronary syndrome (ACS), there is residual and variable risk of recurrent ischemic events.. This study aimed to develop biomarker-based prediction models for 1-year risk of cardiovascular (CV) death and myocardial infarction (MI) in patients with ACS undergoing percutaneous coronary intervention.. We included 10,713 patients from the PLATO (A Comparison of Ticagrelor [AZD6140] and Clopidogrel in Patients With Acute Coronary Syndrome) trial in the development cohort and externally validated in 3,508 patients from the TRACER (Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome) trial. Variables contributing to risk of CV death/MI were assessed using Cox regression models, and a score was derived using subsets of variables approximating the full model.. An 8-item score for the prediction of CV death/MI was developed and validated for patients with ACS undergoing percutaneous coronary intervention. The ABC-ACS ischemia score showed good calibration and discrimination and might be useful for risk prediction and decision support in patients with ACS. (A Comparison of Ticagrelor [AZD6140] and Clopidogrel in Patients With Acute Coronary Syndrome [PLATO]; NCT00391872; Trial to Assess the Effects of Vorapaxar [SCH 530348; MK-5348] in Preventing Heart Attack and Stroke in Participants With Acute Coronary Syndrome [TRACER]; NCT00527943).

Topics: Acute Coronary Syndrome; Biomarkers; Clopidogrel; Growth Differentiation Factor 15; Humans; Myocardial Infarction; Natriuretic Peptide, Brain; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors; Ticagrelor; Treatment Outcome

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Blood Proteins; Diabetes Mellitus, Type 2; Dipeptidyl-Peptidase IV Inhibitors; Double-Blind Method; Female; Galectin 3; Galectins; Growth Differentiation Factor 15; Heart Disease Risk Factors; Heart Failure; Hospitalization; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Piperidines; Prognosis; Risk Assessment; Troponin I; Uracil

We evaluated the effects of sleep-study guided multidisciplinary therapy (SGMT) of obstructive sleep apnoea (OSA) in patients presenting with acute coronary syndrome.. Eligible patients were randomized into (1) SGMT, comprised a sleep study during the index admission and continuous positive airway pressure and behavioral therapy for those with at least mild OSA or (2) standard therapy. The primary end point was the change in the plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) level from baseline to the 7-month follow-up.. A total of 159 patients completed the trial. Of the 70 patients randomized to SGMT, 21 (30%), 15 (22%) and 27 (39%) were diagnosed with mild, moderate and severe OSA, respectively. Continuous positive airway pressure and a positional pillow were prescribed to 57 (91%) and 6 (9%) patients with OSA. Although plasma NT-proBNP levels were lower after 7 months compared to the baseline, the levels did not differ significantly between the SGMT and standard therapy groups at baseline (579 ± 1117 vs. 611 ± 899 pg/dL, p = .851) or at 7 months (90 ± 167 vs. 93 ± 174 pg/dL, p = .996). The changes in NT-proBNP levels from baseline to 7 months were similar with SGMT and standard therapy (-489 vs. -518 pg/dL, p = .726). Similar findings were observed for the plasma ST2 and hs-CRP levels.. OSA screening and multifaceted treatment during the sub-acute phase of acute coronary syndrome did not further reduce the levels of cardiovascular biomarkers when compared with standard therapy.. clinicaltrial.gov NCT02599298.

Topics: Acute Coronary Syndrome; Aftercare; Biomarkers; C-Reactive Protein; Cognitive Behavioral Therapy; Combined Modality Therapy; Continuous Positive Airway Pressure; Female; Humans; Male; Mass Screening; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Polysomnography; Sleep Apnea, Obstructive; Treatment Outcome

The genomic regulatory networks underlying the pathogenesis of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) are incompletely understood. As intermediate traits, protein biomarkers report on underlying disease severity and prognosis in NSTE-ACS. We hypothesized that integration of dense microRNA (miRNA) profiling with biomarker measurements would highlight potential regulatory pathways that underlie the relationships between prognostic biomarkers, miRNAs, and cardiovascular phenotypes. We performed miRNA sequencing using whole blood from 186 patients from the TRILOGY-ACS trial. Seven circulating prognostic biomarkers were measured: NH

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Circulating MicroRNA; Cohort Studies; Female; High-Throughput Nucleotide Sequencing; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Osteopontin; Peptide Fragments; Phenotype; Prognosis; Risk Factors; Sequence Analysis, RNA

Objective- The Wnt/wingless signaling antagonist DKK1 (dickkopf-1) regulates platelet-mediated inflammation and may contribute to plaque destabilization. We hypothesized that DKK1 would be associated with cardiovascular outcomes. Approach and Results- We determined DKK1 levels in serum samples obtained before randomization, at discharge, and 1 and 6 months in a subset of 5165 patients with acute coronary syndromes in the PLATO trial (Platelet Inhibition and Patient Outcomes; NCT00391872). The median (interquartile range) DKK1 concentrations were 0.61 (0.20-1.27) ng/mL at baseline and increased during follow-up. The hazard ratio (95% CIs) for the composite end point (cardiovascular death, nonprocedural spontaneous myocardial infarction, or stroke) during 1 year of follow-up, per 50% increase in baseline DKK1 concentration, was 1.06 (1.02-1.10), P=0.0011, and remained significant in fully adjusted analysis with 14 conventional clinical and demographic and 6 biochemical variables, including NT-proBNP (N-terminal pro-B-type natriuretic peptide), hs-TnT (high-sensitivity troponin T), and GDF-15 (growth differentiation factor 15; 1.05 [1.00-1.09]; P=0.028). This association was mainly driven by the association with cardiovascular death, where a gradual increase in event rates was observed with increasing quartiles of DKK1 (2.7%, 3.0%, 4.3%, and 5.0%) and remained significant and unmodified in fully adjusted analysis (hazard ratio, 1.10 [1.04-1.17]; P=0.002). Change in DKK1 and levels at 1 month were unrelated to outcomes. A modifying effect of ticagrelor on DKK1 discharge levels was observed but not associated with prognosis. Conclusions- In patients with acute coronary syndromes treated with dual antiplatelet treatment, admission DKK1 levels were independently associated with a composite of cardiovascular death, myocardial infarction, or stroke and with cardiovascular death alone.

Topics: Acute Coronary Syndrome; Aged; Cardiovascular Diseases; Clopidogrel; Female; Humans; Intercellular Signaling Peptides and Proteins; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Ticagrelor

To define the predictors of long-term mortality in patients with type 2 diabetes mellitus and recent acute coronary syndrome.. A total of 7226 patients from a randomized trial, testing the effect on cardiovascular outcomes of the dual peroxisome proliferator-activated receptor agonist aleglitazar in patients with type 2 diabetes mellitus and recent acute coronary syndrome (AleCardio trial), were analysed. Median follow-up was 2 years. The independent mortality predictors were defined using Cox regression analysis. The predictive information provided by each variable was calculated as percent of total chi-square of the model. All-cause mortality was 4.0%, with cardiovascular death contributing for 73% of mortality. The mortality prediction model included N-terminal proB-type natriuretic peptide (adjusted hazard ratio = 1.68; 95% confidence interval = 1.51-1.88; 27% of prediction), lack of coronary revascularization (hazard ratio = 2.28; 95% confidence interval = 1.77-2.93; 18% of prediction), age (hazard ratio = 1.04; 95% confidence interval = 1.02-1.05; 15% of prediction), heart rate (hazard ratio = 1.02; 95% confidence interval = 1.01-1.03; 10% of prediction), glycated haemoglobin (hazard ratio = 1.11; 95% confidence interval = 1.03-1.19; 8% of prediction), haemoglobin (hazard ratio = 1.01; 95% confidence interval = 1.00-1.02; 8% of prediction), prior coronary artery bypass (hazard ratio = 1.61; 95% confidence interval = 1.11-2.32; 7% of prediction) and prior myocardial infarction (hazard ratio = 1.40; 95% confidence interval = 1.05-1.87; 6% of prediction).. In patients with type 2 diabetes mellitus and recent acute coronary syndrome, mortality prediction is largely dominated by markers of cardiac, rather than metabolic, dysfunction.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Blood Glucose; Chi-Square Distribution; Diabetes Mellitus, Type 2; Double-Blind Method; Female; Glycated Hemoglobin; Humans; Hypoglycemic Agents; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Myocardial Revascularization; Natriuretic Peptide, Brain; Oxazoles; Peptide Fragments; Predictive Value of Tests; Proportional Hazards Models; Risk Assessment; Risk Factors; Thiophenes; Time Factors; Treatment Outcome

Obstructive sleep apnea (OSA) is an emerging risk marker for acute coronary syndrome (ACS). This randomized trial aims to determine the effects of sleep study-guided multidisciplinary therapy (SGMT) comprising overnight sleep study, continuous positive airway pressure, and behavioral therapy for OSA during the subacute phase of ACS. We hypothesize that SGMT will reduce (1) the plasma levels of N-terminal pro brain natriuretic peptide and suppression of tumorigenicity 2; (2) the estimated 10-year risk of cardiovascular mortality as measured by the European Systematic Coronary Risk Evaluation (SCORE) algorithm; and (3) the cardiovascular event rate during a 3-year follow-up, compared with standard therapy. In the SGMT trial, 180 patients presenting with ACS will be randomly assigned to SGMT (n = 90) and standard therapy (n = 90) groups. Both groups will receive guideline-mandated treatment for ACS. Those assigned to SGMT will additionally undergo a sleep study and, if OSA is diagnosed, attend a multidisciplinary OSA clinic where they will receive personalized treatment including continuous positive airway pressure and behavioral/lifestyle counseling. The primary endpoint is the plasma N-terminal pro brain natriuretic peptide concentration at 7-month follow-up. This report presents the baseline characteristics of 117 patients (SGMT group: n =54; standard therapy group: n =63) who had been enrolled into the study as of August 31, 2017. The results of this trial will help us to understand whether active OSA diagnosis and treatment will improve the physiologic and clinical cardiovascular outcomes of this group of patients.

Topics: Acute Coronary Syndrome; Behavior Therapy; Biomarkers; Clinical Protocols; Combined Modality Therapy; Continuous Positive Airway Pressure; Female; Humans; Interleukin-1 Receptor-Like 1 Protein; Male; Middle Aged; Natriuretic Peptide, Brain; Patient Care Team; Peptide Fragments; Research Design; Risk Factors; Singapore; Sleep; Sleep Apnea, Obstructive; Time Factors; Treatment Outcome

Insulin resistance has been linked to development and progression of atherosclerosis and is present in most patients with type 2 diabetes. Whether the degree of insulin resistance predicts adverse outcomes in patients with type 2 diabetes and acute coronary syndrome (ACS) is uncertain.. The Effect of Aleglitazar on Cardiovascular Outcomes after Acute Coronary Syndrome in Patients with Type 2 Diabetes Mellitus trial compared the peroxisome proliferator-activated receptor-α/γ agonist aleglitazar with placebo in patients with type 2 diabetes and recent ACS. In participants not treated with insulin, we determined whether baseline homeostasis model assessment of insulin resistance (HOMA-IR; n = 4303) or the change in HOMA-IR on assigned study treatment (n = 3568) was related to the risk of death or major adverse cardiovascular events (cardiovascular death, myocardial infarction, and stroke) in unadjusted and adjusted models. Because an inverse association of HOMA-IR with N-terminal pro-B-type natriuretic peptide (NT-proBNP) has been described, we specifically examined effects of adjustment for the latter.. In unadjusted analysis, twofold higher baseline HOMA-IR was associated with lower risk of death [hazard ratio (HR): 0.79, 95% CI: 0.68 to 0.91, P = 0.002]. Adjustment for 24 standard demographic and clinical variables had minimal effect on this association. However, after further adjustment for NT-proBNP, the association of HOMA-IR with death was no longer present (adjusted HR: 0.99, 95% CI: 0.83 to 1.19, P = 0.94). Baseline HOMA-IR was not associated with major adverse cardiovascular events, nor was the change in HOMA-IR on study treatment associated with death or major adverse cardiovascular events.. After accounting for levels of NT-proBNP, insulin resistance assessed by HOMA-IR is not related to the risk of death or major adverse cardiovascular events in patients with type 2 diabetes and ACS.

Topics: Acute Coronary Syndrome; Aged; Diabetes Mellitus, Type 2; Female; Homeostasis; Humans; Hypoglycemic Agents; Insulin; Insulin Resistance; Male; Middle Aged; Natriuretic Peptide, Brain; Oxazoles; Peptide Fragments; Proportional Hazards Models; Risk Assessment; Risk Factors; Survival Analysis; Thiophenes

Inflammation and dysregulated immune responses play a crucial role in atherosclerosis, underlying ischaemic heart disease (IHD) and acute coronary syndromes (ACSs). Immune responses are also major determinants of the postischaemic injury in myocardial infarction. Regulatory T cells (CD4. Low-dose interleukin-2 in patients with stable ischaemic heart disease and acute coronary syndromes is a single-centre, first-in-class, dose-escalation, two-part clinical trial. Patients with stable IHD (part A) and ACS (part B) will be randomised to receive either IL-2 (aldesleukin; dose range 0.3-3×10. The study received a favourable opinion by the Greater Manchester Central Research Ethics Committee, UK (17/NW/0012). The results of this study will be reported through peer-reviewed journals, conference presentations and an internal organisational report.. NCT03113773; Pre-results.

Topics: Acute Coronary Syndrome; C-Reactive Protein; Clinical Trials, Phase I as Topic; Clinical Trials, Phase II as Topic; Double-Blind Method; Humans; Immunologic Factors; Interleukin-2; Interleukin-6; Lymphocyte Count; Myocardial Ischemia; Natriuretic Peptide, Brain; Randomized Controlled Trials as Topic; Recombinant Proteins; T-Lymphocytes, Regulatory; Troponin

Mortality remains at about 5% within a year after an acute coronary syndrome event. Prior studies have assessed biomarkers in relation to all-cause or cardiovascular deaths but not across multiple causes.. To assess if different biomarkers provide information about the risk for all-cause and cause-specific mortality.. The Platelet Inhibition and Patient Outcomes (PLATO) trial randomized 18 624 patients with acute coronary syndrome to ticagrelor or clopidogrel from October 2006 through July 2008. In this secondary analysis biomarker substudy, 17 095 patients participated.. Death due to myocardial infarction, heart failure, sudden cardiac death/arrhythmia, bleeding, procedures, other vascular causes, and nonvascular causes, as well as all-cause death.. At baseline, levels of cystatin-C, growth differentiation factor-15 (GDF-15), high-sensitivity C-reactive protein, high-sensitivity troponin I and T, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were determined.. The median (interquartile range) age of patients was 62.0 (54.0-71.0) years. Of 17 095 patients, 782 (4.6%) died during follow-up. The continuous associations between biomarkers and all-cause and cause-specific mortality were modeled using Cox models and presented as hazard ratio (HR) comparing the upper vs lower quartile. For all-cause mortality, NT-proBNP and GDF-15 were the strongest markers with adjusted HRs of 2.96 (95% CI, 2.33-3.76) and 2.65 (95% CI, 2.17-3.24), respectively. Concerning death due to heart failure, NT-proBNP was associated with an 8-fold and C-reactive protein, GDF-15, and cystatin-C, with a 3-fold increase in risk. Regarding sudden cardiac death/arrhythmia, NT-proBNP was associated with a 4-fold increased risk and GDF-15 with a doubling in risk. Growth differentiation factor-15 had the strongest associations with other vascular and nonvascular deaths and was possibly associated with death due to major bleeding (HR, 4.91; 95% CI, 1.39-17.43).. In patients with acute coronary syndrome, baseline levels of NT-proBNP and GDF-15 were strong markers associated with all-cause death based on their associations with death due to heart failure as well as due to arrhythmia and sudden cardiac death. Growth differentiation factor-15 had the strongest associations with death due to other vascular or nonvascular causes and possibly with death due to bleeding.. ClinicalTrials.gov Identifier: NCT00391872.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; C-Reactive Protein; Cause of Death; Europe; Female; Follow-Up Studies; Growth Differentiation Factor 15; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Platelet Aggregation Inhibitors; Prognosis; Prospective Studies; Protein Precursors; Risk Assessment; Risk Factors; Survival Rate; Troponin T; United States

Clinical scores and biomarkers improve risk stratification of patients with acute coronary syndromes. However, little is known about their value in patients referred for coronary angiography.. Consecutive patients admitted at four Swiss university hospitals with a diagnosis of acute coronary syndrome were enrolled into the SPUM-ACS Biomarker Cohort between 2009 and 2012. Patients were followed at 30 days and 1 year with assessment of adjudicated events including all-cause mortality and the composite of all-cause mortality or non-fatal recurrent myocardial infarction.. Events and biomarkers were analysed in 1892 patients (52.4% with ST-segment elevation myocardial infarction, 43.3% with non-ST-segment elevation myocardial infarction and 4.3% with unstable angina). Death at 30 days occurred in 35 patients (1.9%) and at 1 year in 80 patients (4.3%). The choice of troponin assay (conventional versus high sensitivity) to calculate the Global Registry of Acute Coronary Events (GRACE) score did not affect risk prediction. The prognostic accuracy of the GRACE score was improved when combined with three individual biomarkers including high sensitivity troponin T (hsTnT), N-terminal-pro B-type natriuretic peptide (NT-proBNP) and high sensitivity C-reactive protein (hsCRP) to yield a 9% increment (C-statistic 0.73->0.82) for the discrimination of short-term risk for all-cause mortality. In contrast, the novel biomarkers placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1) and the ratio sFlt-1/PlGF did not improve risk stratification.. In patients with acute coronary syndrome referred for coronary angiography, combinations of biomarkers including hsTnT, NT-proBNP and hsCRP with the GRACE score enhanced risk discrimination.. NCT01000701.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; C-Reactive Protein; Cause of Death; Coronary Angiography; Female; Follow-Up Studies; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Prospective Studies; Protein Precursors; Registries; Risk Assessment; Risk Factors; Survival Rate; Switzerland; Troponin T

Natriuretic peptides are recognized as important predictors of cardiovascular events in patients with heart failure, but less is known about their prognostic importance in patients with acute coronary syndrome. We sought to determine whether B-type natriuretic peptide (BNP) and N-terminal prohormone B-type natriuretic peptide (NT-proBNP) could enhance risk prediction of a broad range of cardiovascular outcomes in patients with acute coronary syndrome and type 2 diabetes mellitus.. Patients with a recent acute coronary syndrome and type 2 diabetes mellitus were prospectively enrolled in the ELIXA trial (n=5525, follow-up time 26 months). Best risk models were constructed from relevant baseline variables with and without BNP/NT-proBNP. C statistics, Net Reclassification Index, and Integrated Discrimination Index were analyzed to estimate the value of adding BNP or NT-proBNP to best risk models. Overall, BNP and NT-proBNP were the most important predictors of all outcomes examined, irrespective of history of heart failure or any prior cardiovascular disease. BNP significantly improved C statistics when added to risk models for each outcome examined, the strongest increments being in death (0.77-0.82,. In patients with a recent acute coronary syndrome and type 2 diabetes mellitus, BNP and NT-proBNP were powerful predictors of cardiovascular outcomes beyond heart failure and death, ie, were also predictive of MI and stroke. Natriuretic peptides added as much predictive information about death as all other conventional variables combined.. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01147250.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Cause of Death; Diabetes Mellitus, Type 2; Female; Heart Failure; Humans; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Prospective Studies; Risk Assessment; Risk Factors; Stroke; Time Factors

Psychological constructs are associated with cardiovascular health, but the biological mechanisms mediating these relationships are unknown. We examined relationships between psychological constructs and markers of inflammation, endothelial function, and myocardial strain in a cohort of post-acute coronary syndrome (ACS) patients.. Participants (N = 164) attended study visits 2 weeks and 6 months after ACS. During these visits, they completed self-report measures of depressive symptoms, anxiety, optimism, and gratitude; and blood samples were collected for measurement of biomarkers reflecting inflammation, endothelial function, and myocardial strain. Generalized estimating equations and linear regression analyses were performed to examine concurrent and prospective relationships between psychological constructs and biomarkers.. In concurrent analyses, depressive symptoms were associated with elevated markers of inflammation (interleukin-17: β = .047; 95% confidence interval [CI] = .010-.083]), endothelial dysfunction (endothelin-1: β = .020; 95% [CI] = .004-.037]), and myocardial strain (N-terminal pro-B-type natriuretic peptide: β = .045; 95% [CI] = .008-.083]), independent of age, sex, medical variables, and anxiety, whereas anxiety was not associated with these markers in multivariable adjusted models. Optimism and gratitude were associated with lower levels of markers of endothelial dysfunction (endothelin-1: gratitude: β = -.009; 95% [CI] = -.017 to - .001]; optimism: β = -.009; 95% [CI] = -.016 to - .001]; soluble intercellular adhesion molecule-1: gratitude: β = -.007; 95% [CI] = -.014 to - .000]), independent of depressive and anxiety symptoms. Psychological constructs at 2 weeks were not prospectively associated with biomarkers at 6 months.. Depressive symptoms were associated with more inflammation, myocardial strain, and endothelial dysfunction in the 6 months after ACS, whereas positive psychological constructs were linked to better endothelial function. Larger prospective studies may clarify the directionality of these relationships.. Clinicaltrials.gov identifier NCT01709669.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Depression; Endothelin-1; Female; Follow-Up Studies; Humans; Inflammation; Intercellular Adhesion Molecule-1; Interleukin-17; Male; Middle Aged; Natriuretic Peptide, Brain; Optimism; Peptide Fragments

To determine the effect of the glucagon-like peptide-1 analogue liraglutide on left ventricular function in chronic heart failure patients with and without type 2 diabetes.. LIVE was an investigator-initiated, randomised, double-blinded, placebo-controlled multicentre trial. Patients (n = 241) with reduced left ventricular ejection fraction (LVEF ≤45%) were recruited (February 2012 to August 2015). Patients were clinically stable and on optimal heart failure treatment. Intervention was liraglutide 1.8 mg once daily or matching placebo for 24 weeks. The LVEF was similar at baseline in the liraglutide and the placebo group (33.7 ± 7.6% vs. 35.4 ± 9.4%). Change in LVEF did not differ between the liraglutide and the placebo group; mean difference (95% confidence interval) was -0.8% (-2.1, 0.5; P = 0.24). Heart rate increased with liraglutide [mean difference: 7 b.p.m. (5, 9), P < 0.0001]. Serious cardiac events were seen in 12 (10%) patients treated with liraglutide compared with 3 (3%) patients in the placebo group (P = 0.04).. Liraglutide did not affect left ventricular systolic function compared with placebo in stable chronic heart failure patients with and without diabetes. Treatment with liraglutide was associated with an increase in heart rate and more serious cardiac adverse events, and this raises some concern with respect to the use of liraglutide in patients with chronic heart failure and reduced left ventricular function. More data on the safety of liraglutide in different subgroups of heart failure patients are needed.

Topics: Acute Coronary Syndrome; Aged; Atrial Fibrillation; Chronic Disease; Diabetes Mellitus, Type 2; Disease Progression; Double-Blind Method; Echocardiography; Female; Heart Failure; Heart Rate; Humans; Incretins; Liraglutide; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Stroke Volume; Tachycardia, Ventricular; Treatment Outcome; Ventricular Function, Left; Walk Test

Clinical presentation of takotsubo syndrome (TTS) mimics acute coronary syndrome (ACS) and does not allow differentiation. We aimed to develop a clinical score to estimate the probability of TTS and to distinguish TTS from ACS in the acute stage.. Patients with TTS were recruited from the International Takotsubo Registry ( www.takotsubo-registry.com) and ACS patients from the leading hospital in Zurich. A multiple logistic regression for the presence of TTS was performed in a derivation cohort (TTS, n = 218; ACS, n = 436). The best model was selected and formed a score (InterTAK Diagnostic Score) with seven variables, and each was assigned a score value: female sex 25, emotional trigger 24, physical trigger 13, absence of ST-segment depression (except in lead aVR) 12, psychiatric disorders 11, neurologic disorders 9, and QTc prolongation 6 points. The area under the curve (AUC) for the resulting score was 0.971 [95% confidence interval (CI) 0.96-0.98] and using a cut-off value of 40 score points, sensitivity was 89% and specificity 91%. When patients with a score of ≥50 were diagnosed as TTS, nearly 95% of TTS patients were correctly diagnosed. When patients with a score ≤31 were diagnosed as ACS, ∼95% of ACS patients were diagnosed correctly. The score was subsequently validated in an independent validation cohort (TTS, n = 173; ACS, n = 226), resulting in a score AUC of 0.901 (95% CI 0.87-0.93).. The InterTAK Diagnostic Score estimates the probability of the presence of TTS and is able to distinguish TTS from ACS with a high sensitivity and specificity.. NCT0194762.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Diagnosis, Differential; Electrocardiography; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Propensity Score; Prospective Studies; Registries; ROC Curve; Takotsubo Cardiomyopathy; Troponin

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.. 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).. 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.. 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.

Topics: Acute Coronary Syndrome; Biomarkers; Blood Platelets; Coronary Angiography; Growth Differentiation Factor 15; Humans; Myocardial Revascularization; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Risk Assessment; Treatment Outcome; Troponin T

Higher N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels have been linked to a more favorable glucometabolic profile. Little is known about the interaction of NT-proBNP and fasting glucose in non-ST-segment elevation acute coronary syndrome (NSTE ACS).. Fasting glucose and NT-proBNP were measured in 2240 patients enrolled in the EARLY ACS trial. Multivariable Cox models were used to assess associations between fasting glucose and NT-proBNP and a 96-hour composite of death, myocardial infarction (MI), recurrent ischemia, or thrombotic bailout; 30-day death or MI; and 1-year mortality.. NT-proBNP and fasting glucose concentrations were associated with intermediate-term ischemic outcomes and may identify differential response to treatment with eptifibatide. CLINICALTRIALS.. NCT00089895.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Blood Glucose; Coronary Angiography; Dose-Response Relationship, Drug; Electrocardiography; Eptifibatide; Fasting; Female; Follow-Up Studies; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Peptides; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors; Platelet Glycoprotein GPIIb-IIIa Complex; Treatment Outcome

Growth differentiation factor-15 (GDF-15) predicts death and composite cardiovascular (CV) events in patients with acute coronary syndrome (ACS). We investigated the independent associations between GDF-15 levels and major bleeding, the extent of coronary lesions and individual CV events in patients with ACS.. Growth differentiation factor-15 was analysed at baseline ( ITALIC! n = 16 876) in patients with ACS randomized to ticagrelor or clopidogrel in the PLATO (PLATelet inhibition and patient Outcomes) trial. Growth differentiation factor-15 levels were related to extent of coronary artery disease (CAD) and to all types of non-coronary artery bypass grafting (CABG)-related major bleeding, spontaneous myocardial infarction (MI), stroke, and death during 12-month follow-up. In Cox proportional hazards models adjusting for established risk factors for CV disease and prognostic biomarkers (N-terminal pro B-type natriuretic peptide, cystatin C, high-sensitive C-reactive protein, and high-sensitive troponin T), 1 SD increase in ln GDF-15 was associated with increased risk of major bleeding with a hazard ratio (HR) 1.37 (95% confidence interval: 1.25-1.51) and with a similar increase in risk across different bleeding locations. For the same increase in ln GDF-15, the HR for the composite of CV death, spontaneous MI, and stroke was 1.29 (1.21-1.37), CV death 1.41 (1.30-1.53), all-cause death 1.41 (1.31-1.53), spontaneous MI 1.15 (1.05-1.26), and stroke 1.19 (1.01-1.42). The ITALIC! C-statistic improved for the prediction of CV death and non-CABG-related major bleeding when adding GDF-15 to established risk factors.. In patients with ACS, higher levels of GDF-15 are associated with raised risks of all types of major non-CABG-related bleeding, spontaneous MI, and stroke as well as CV and total mortality and seem to improve risk stratification for CV-mortality and major bleeding beyond established risk factors.. www.clinicaltrials.gov; NCT00391872.

Topics: Acute Coronary Syndrome; C-Reactive Protein; Growth Differentiation Factor 15; Hemorrhage; Humans; Natriuretic Peptide, Brain; Platelet Aggregation Inhibitors; Ticlopidine; Treatment Outcome; Troponin T

Vascular inflammation plays a key role in the development of atherosclerosis and acute coronary syndrome (ACS), and pentraxin 3 (PTX3) is one of several novel, promising markers of inflammation. In addition, D-dimer might serve as a marker of thrombogenesis and a hypercoagulable state following plaque rupture. The present study assesses the prognostic utility of these two biomarkers as compared to high-sensitivity C-reactive protein (hsCRP) and B-type natriuretic peptide (BNP), in addition to conventional clinical risk factors for coronary heart disease in patients with suspected ACS.. Chest pain patients with suspected ACS (n = 871) were consecutively included in a prospective, observational study with a follow-up time of 84 months.. At 7-year follow-up, 332 patients had died and 203 had suffered an adverse troponin T-positive, non-fatal cardiac event. In the multivariate analysis, levels of PTX3 above 5.88 ng/mL (median) and D-dimer above 436 µg/L (lower limit upper quartile) independently predicted mortality (HR 1.60 [95% CI 1.10-2.33]; p = 0.014 and HR 1.83 [95% CI 1.20-2.78]; p = 0.005, respectively). Also, BNP levels above 310.75 pg/mL (lower limit upper quartile) (HR 2.16 [95% CI 1.37-3.42]; p = 0.001), but not hsCRP, independently predicted mortality. Only hsCRP and BNP also predicted future myocardial infarction (HR 1.59 [95% CI 1.05-2.40]; p = 0.029 and HR 1.91 [95% CI 1.10-3.31]; p = 0.021, respectively).. High levels of PTX3, D-dimer and BNP were found to be independent, long-term predictors of all-cause mortality in chest pain patients with a suspected ACS. hsCRP and BNP also predicted future myocardial infarction.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; C-Reactive Protein; Cause of Death; Enzyme-Linked Immunosorbent Assay; Female; Fibrin Fibrinogen Degradation Products; Follow-Up Studies; Humans; Immunoturbidimetry; Inflammation; Male; Middle Aged; Natriuretic Peptide, Brain; Norway; Prognosis; Prospective Studies; Serum Amyloid P-Component; Survival Rate; Time Factors

Nonsustained ventricular tachycardia (NSVT) is common after acute coronary syndrome (ACS) and a marker of increased risk of arrhythmogenic death. However, the prognostic significance of NSVT when evaluated with other contemporary risk markers and at later time points after ACS remains uncertain.. In the Platelet Inhibition and Patient Outcomes (PLATO) trial, continuous ECGs were performed during the first 7 days after ACS (n=2866) and repeated for another 7 days at day 30 (n=1991). Median follow-up was 1 year. There was a time-varying interaction between NSVT and cardiovascular death such that NSVT was significantly associated with increased risk within the first 30 days after randomization (22/999 [2.2%] versus 16/1825 [0.9%]; adjusted hazard ratio, 2.84; 95% confidence interval, 1.39-5.79; P=0.004) but not after 30 days (28/929 [3.0%] versus 42/1734 [2.4%]; P=0.71). Detection of NSVT during the convalescent phase (n=428/1991; 21.5%) was also associated with an increased risk of cardiovascular death, and was most marked within the first 2 months after detection (1.9% versus 0.3%; adjusted hazard ratio, 5.48; 95% confidence interval, 1.07-28.20; P=0.01), and then decreasing over time such that the relationship was no longer significant by ≈5 months after ACS.. NSVT occurred frequently during the acute and convalescent phases of ACS. The risk of cardiovascular death associated with NSVT was the greatest during the first 30 days after presentation; however, patients with NSVT detected during the convalescent phase were also at a significantly increased risk of cardiovascular death that persisted for an additional several months after the index event.. http://www.clinicaltrials.gov. Unique identifier: NCT00391872.

Topics: Acute Coronary Syndrome; Adenosine; Aged; Biomarkers; Cause of Death; Clopidogrel; Death, Sudden, Cardiac; Electrocardiography; Female; Humans; Incidence; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Platelet Aggregation Inhibitors; Risk Assessment; Risk Factors; Tachycardia, Ventricular; Ticagrelor; Ticlopidine; Time Factors; Treatment Outcome

N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a strong predictor of mortality in coronary artery disease and is widely employed as a prognostic biomarker. However, a causal relationship between NT-proBNP and clinical endpoints has not been established. We have performed a genome-wide association and Mendelian randomization study of NT-proBNP. We used a discovery set of 3740 patients from the PLATelet inhibition and patient Outcomes (PLATO) trial, which enrolled 18 624 patients with acute coronary syndrome (ACS). A further set of 5492 patients, from the same trial, was used for replication. Genetic variants at two novel loci (SLC39A8 and POC1B/GALNT4) were associated with NT-proBNP levels and replicated together with the previously known NPPB locus. The most significant SNP (rs198389, pooled P = 1.07 × 10(-15)) in NPPB interrupts an E-box consensus motif in the gene promoter. The association in SLC39A8 is driven by a deleterious variant (rs13107325, pooled P = 5.99 × 10(-10)), whereas the most significant SNP in POC1B/GALNT4 (rs11105306, pooled P = 1.02 × 10(-16)) is intronic. The SLC39A8 SNP was associated with higher risk of cardiovascular (CV) death (HR = 1.39, 95% CI: 1.08-1.79, P = 0.0095), but the other loci were not associated with clinical endpoints. We have identified two novel loci to be associated with NT-proBNP in patients with ACS. Only the SLC39A8 variant, but not the NPPB variant, was associated with a clinical endpoint. Due to pleotropic effects of SLC39A8, these results do not suggest that NT-proBNP levels have a direct effect on mortality in ACS patients. PLATO Clinical Trial Registration: www.clinicaltrials.gov; NCT00391872.

Topics: Acute Coronary Syndrome; Cation Transport Proteins; Cell Cycle Proteins; Genome-Wide Association Study; Humans; Mendelian Randomization Analysis; Middle Aged; N-Acetylgalactosaminyltransferases; Natriuretic Peptide, Brain; Peptide Fragments; Polymorphism, Single Nucleotide; Polypeptide N-acetylgalactosaminyltransferase

The FRISC-II trial was the first randomised trial to show a reduction in death or myocardial infarction with an early invasive versus a non-invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome. Here we provide a remaining lifetime perspective on the effects on all cardiovascular events during 15 years' follow-up.. The FRISC-II prospective, randomised, multicentre trial was done at 58 Scandinavian centres in Sweden, Denmark, and Norway. Between June 17, 1996, and Aug 28, 1998, we randomly assigned (1:1) 2457 patients with non-ST-elevation acute coronary syndrome to an early invasive treatment strategy, aiming for revascularisation within 7 days, or a non-invasive strategy, with invasive procedures at recurrent symptoms or severe exercise-induced ischaemia. Plasma for biomarker analyses was obtained at randomisation. For long-term outcomes, we linked data with national health-care registers. The primary endpoint was a composite of death or myocardial infarction. Outcomes were compared as the average postponement of the next event, including recurrent events, calculated as the area between mean cumulative count-of-events curves. Analyses were done by intention to treat.. At a minimum of 15 years' follow-up on Dec 31, 2014, data for survival status and death were available for 2421 (99%) of the initially recruited 2457 patients, and for other events after 2 years for 2182 (89%) patients. During follow-up, the invasive strategy postponed death or next myocardial infarction by a mean of 549 days (95% CI 204-888; p=0·0020) compared with the non-invasive strategy. This effect was larger in non-smokers (mean gain 809 days, 95% CI 402-1175; p. During 15 years of follow-up, an early invasive treatment strategy postponed the occurrence of death or next myocardial infarction by an average of 18 months, and the next readmission to hospital for ischaemic heart disease by 37 months, compared with a non-invasive strategy in patients with non-ST-elevation acute coronary syndrome. This remaining lifetime perspective supports that an early invasive treatment strategy should be the preferred option in most patients with non-ST-elevation acute coronary syndrome.. Swedish Heart-Lung Foundation, Swedish Foundation for Strategic Research, and Uppsala Clinical Research Center.

Topics: Acute Coronary Syndrome; Adult; Aged; Biomarkers; Diabetes Complications; Female; Follow-Up Studies; Heart Conduction System; Humans; Hypertension; Male; Middle Aged; Minimally Invasive Surgical Procedures; Myocardial Infarction; Natriuretic Peptide, Brain; Patient Readmission; Peptide Fragments; Prospective Studies; Scandinavian and Nordic Countries; Secondary Prevention; Time Factors; Treatment Outcome; Troponin T

The EXAMINE trial showed non-inferiority of the DPP-4 inhibitor alogliptin to placebo on major adverse cardiac event (MACE) rates in patients with type 2 diabetes and recent acute coronary syndromes. Concerns about excessive rates of in-hospital heart failure in another DPP-4 inhibitor trial have been reported. We therefore assessed hospital admission for heart failure in the EXAMINE trial.. Patients with type 2 diabetes and an acute coronary syndrome event in the previous 15-90 days were randomly assigned alogliptin or placebo plus standard treatment for diabetes and cardiovascular disease prevention. The prespecified exploratory extended MACE endpoint was all-cause mortality, non-fatal myocardial infarction, non-fatal stroke, urgent revascularisation due to unstable angina, and hospital admission for heart failure. The post-hoc analyses were of cardiovascular death and hospital admission for heart failure, assessed by history of heart failure and brain natriuretic peptide (BNP) concentration at baseline. We also assessed changes in N-terminal pro-BNP (NT-pro-BNP) from baseline to 6 months. This study is registered with ClinicalTrials.gov, number NCT00968708.. 5380 patients were assigned to alogliptin (n=2701) or placebo (n=2679) and followed up for a median of 533 days (IQR 280-751). The exploratory extended MACE endpoint was seen in 433 (16·0%) patients assigned to alogliptin and in 441 (16·5%) assigned to placebo (hazard ratio [HR] 0·98, 95% CI 0·86-1·12). Hospital admission for heart failure was the first event in 85 (3·1%) patients taking alogliptin compared with 79 (2·9%) taking placebo (HR 1·07, 95% CI 0·79-1·46). Alogliptin had no effect on composite events of cardiovascular death and hospital admission for heart failure in the post hoc analysis (HR 1·00, 95% CI 0·82-1·21) and results did not differ by baseline BNP concentration. NT-pro-BNP concentrations decreased significantly and similarly in the two groups.. In patients with type 2 diabetes and recent acute coronary syndromes, alogliptin did not increase the risk of heart failure outcomes.. Takeda Development Center Americas.

Topics: Acute Coronary Syndrome; Aged; Angina, Unstable; Diabetes Mellitus, Type 2; Diabetic Cardiomyopathies; Double-Blind Method; Female; Heart Failure; Hospitalization; Humans; Hypoglycemic Agents; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Piperidines; Risk Factors; Stroke; Uracil

Risk stratification and the use of specific biomarkers have been proposed for tailoring treatment in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). We investigated the prognostic importance of high-sensitivity troponin T (hs-TnT), N-terminal pro-brain natriuretic peptide (NT-proBNP), and growth differentiation factor-15 (GDF-15) in relation to randomized treatment (ticagrelor versus clopidogrel) and management strategy (with or without revascularization) in the NSTE-ACS subgroup of the Platelet Inhibition and Patient Outcomes (PLATO) trial.. Of 18 624 patients in the PLATO trial, 9946 had an entry diagnosis of NSTE-ACS and baseline blood samples available. During index hospitalization, 5357 were revascularized, and 4589 were managed without revascularization. Hs-TnT, NT-proBNP, and GDF-15 were determined and assessed according to predefined cutoff levels. Median follow-up was 9.1 months. Increasing levels of hs-TnT were associated with increasing risk of cardiovascular death, myocardial infarction, and stroke in medically managed patients (P<0.001), but not in those managed invasively. NT-proBNP and GDF-15 levels were associated with the same events independent of management strategy. Ticagrelor versus clopidogrel reduced the rate of cardiovascular death, myocardial infarction, and stroke in patients with NSTE-ACS and hs-TnT ≥14.0 ng/L in both invasively and noninvasively managed patients; in patients with hs-TnT <14.0 ng/L, there was no difference between ticagrelor and clopidogrel in the noninvasive group. Hs-TnT, NT-proBNP, and GDF-15 are predictors of cardiovascular death, myocardial infarction, and stroke in patients with NSTE-ACS managed noninvasively, and NT-proBNP and GDF-15 also in those managed invasively. Elevated hs-TnT predicts substantial benefit of ticagrelor over clopidogrel both in invasively and noninvasively managed patients, but no apparent benefit was seen at normal hs-TnT.. URL:http://www.clinicaltrials.gov. Unique identifier: NCT00391872.

Topics: Acute Coronary Syndrome; Adenosine; Biomarkers; Clopidogrel; Electrocardiography; Growth Differentiation Factor 15; Hospital Mortality; Humans; Kaplan-Meier Estimate; Myocardial Revascularization; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Prospective Studies; Purinergic P2Y Receptor Antagonists; Risk Factors; Ticagrelor; Ticlopidine; Troponin T

Postoperative heart failure remains the major cause of death after cardiac surgery. As N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a predictor for postoperative heart failure, the aim was to evaluate if preoperative NT-proBNP could provide additional prognostic information to the recently launched EuroSCORE II.. A total of 365 patients with acute coronary syndrome (ACS) undergoing isolated coronary artery bypass graft (CABG) surgery were studied prospectively. Preoperative NT-proBNP and EuroSCORE II were evaluated with regard to severe circulatory failure after operation according to prespecified criteria. To assess what clinical outcomes are indicated by NT-proBNP levels in different risk categories, the patients were stratified according to EuroSCORE II. Based on receiver operating characteristics analysis, these cohorts were assessed with regard to preoperative NT-proBNP below or above 1028 ng litre(-1). The follow-up time averaged 4.4 (0.7) yr.. Preoperative NT-proBNP≥1028 ng litre(-1) [odds ratio (OR) 9.9, 95% confidence interval (CI) 1.01-98.9; P=0.049] and EuroSCORE II (OR 1.24, 95% CI 1.06-1.46; P=0.008) independently predicted severe circulatory failure after operation. In intermediate-risk patients (EuroSCORE II 2.0-10.0), NT-proBNP≥1028 ng litre(-1) was associated with a higher incidence of severe circulatory failure (6.6% vs 0%; P=0.007), renal failure (14.8% vs 5.4%; P=0.03), stroke (6.6% vs 0.7%; P=0.03), longer intensive care unit stay [37 (35) vs 27 (38) h; P=0.002], and worse long-term survival.. Combining EuroSCORE II and preoperative NT-proBNP appears to improve risk prediction with regard to severe circulatory failure after isolated CABG for ACS. NT-proBNP may be particularly useful in patients at intermediate risk according to EuroSCORE II.. NCT00489827.

Topics: Acute Coronary Syndrome; Adult; Aged; Aged, 80 and over; Biomarkers; Coronary Artery Bypass; Female; Hospital Mortality; Humans; Longitudinal Studies; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Preoperative Care; Prognosis; Prospective Studies; Risk Assessment; Severity of Illness Index; Shock; Sweden; Treatment Outcome

The outcomes of acute cardiovascular symptom presentations are potentially modifiable with the use of biomarkers to accelerate accurate diagnosis. This randomized trial tested troponin and B-type natriuretic peptide before hospital guidance in patients with acute cardiovascular symptoms.. Patients with either chest pain or shortness of breath were randomized to usual care or biomarkers analyzed using a point-of-care device in the ambulance. The primary end point was time to final disposition (discharge from the emergency department or admission to hospital). The trial was stopped prematurely because of less than expected enrollment of patients of interest and no difference in the primary end point.. We randomized 491 patients; 480 formed the final cohort. Patients were 49% male; median age 70 years; 42% had previous acute coronary syndrome; and 28% diabetes. The B-type natriuretic peptide level before hospital arrival was ≥ 100 pg/mL in 36.4%. Troponin was > 0.03 ng/mL in 13.4%; 3.6% had troponin > 0.1 ng/mL. After adjudication, 16% had acute coronary syndrome, 6.5% acute heart failure, 3.3% angina, and 74.2% another diagnosis. The primary end point was 9.2 (interquartile range, 7.3-11.1) hours in the biomarker group and 8.8 (interquartile range, 6.3-12.1) hours in the usual care group (P = 0.6). None died in the ambulance or in the emergency department: all-cause 30-day mortality was 2.1% (usual care) and 1.7% (biomarker).. To our knowledge, this is the first randomized trial of biomarkers before hospital arrival to guide emergency management of suspected acute cardiovascular disease which showed no benefit and was terminated early because of futility. The results have important implications for the use of biomarkers in emergency management of heart disease and for the design of future randomized trials on this important topic.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Early Termination of Clinical Trials; Emergency Medical Services; Emergency Service, Hospital; Female; Heart Failure; Hospitalization; Humans; Intention to Treat Analysis; Male; Natriuretic Peptide, Brain; Point-of-Care Systems; Troponin

Statins reduce the incidence of cardiovascular events after percutaneous coronary intervention (PCI), but no clinical studies have investigated the role of statins in ischemia-reperfusion injury after PCI.. Rosuvastatin could reduce ischemia-reperfusion injury in patients with acute coronary syndrome treated with PCI.. We investigated the effects of rosuvastatin on ischemia-reperfusion injury in patients with acute coronary syndrome after PCI and evaluated short-term prognosis.. Patients scheduled for emergent PCI were given either rosuvastatin for ≥6 months (10 mg/d, every night; n = 55) or no statins (control group; n = 65). Serum superoxide dismutase activity, malondialdehyde, brain natriuretic peptide (BNP), and high-sensitivity C-reactive protein (hs-CRP) were determined before and after PCI, as well as left ventricular ejection fraction and left ventricular end-diastolic volume. Major adverse cardiac events were observed at follow-ups for 6 months.. Superoxide dismutase activity in the rosuvastatin-treated group was higher than that of the control group; serum levels of malondialdehyde were lower. BNP and hs-CRP levels in the rosuvastatin-treated group were lower than that of the control group. Four weeks after PCI, the left ventricular ejection fraction in the treatment group was higher than that of the control group, and the left ventricular end-diastolic volume was lower. At the 6-month follow-up, there was no difference in major adverse cardiac events between the 2 groups.. Rosuvastatin before PCI reduced ischemia-reperfusion injury in patients with acute coronary syndrome, which suggests the importance of application of rosuvastatin before PCI for early intervention.

Topics: Acute Coronary Syndrome; Biomarkers; China; Female; Fluorobenzenes; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Male; Malondialdehyde; Middle Aged; Myocardial Reperfusion Injury; Natriuretic Peptide, Brain; Percutaneous Coronary Intervention; Pyrimidines; Rosuvastatin Calcium; Stroke Volume; Sulfonamides; Superoxide Dismutase; Time Factors; Treatment Outcome; Ventricular Function, Left

We examined 140 patients (mean age 54.8±3.1 years) with ST elevation acute coronary syndrome resulting in Q-wave myocardial infarction of the left ventricle. From the first hours complex therapy of these patients comprised meldonium (1 g/day intravenously for 2 weeks then orally until 1.5 months). Therapy with meldonium accelerated restoration of left ventricular diastolic function what was in agreement with lowering of NT-proBNT concentration in blood. It was established that administration of meldonium led to reduction of number of high grade ventricular extrasystoles during first 6 hours after thrombolysis, to lowering of blood concentration of lipoperoxide degradation products. Early use of meldonium decreases probability of emergence of fatal arrhythmias and improves prognosis of hospital stage of rehabilitation of patients with acute coronary syndrome resulting in Q-wave myocardial infarction.

Topics: Acute Coronary Syndrome; Cardiovascular Agents; Coronary Angiography; Diastole; Drug Administration Routes; Drug Monitoring; Electrocardiography; Female; Humans; Male; Methylhydrazines; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Treatment Outcome; Ventricular Function, Left

To observe the effect of Wenxin Granule (WG) on brain natriuretic peptide (BNP) and heart rate variability (HRV) of acute coronary syndrome (ACS) patients.. Totally 65 ACS patients were randomly assigned to the treatment group (35 cases) and the control group (30 cases). All patients were treated with routine therapies such as angiotensin conversing enzyme inhibitors (ACEI) and metoprolol. Those in the treatment group took WG, 9 g each time, three times daily. All were treated for 90 days. Plasma samples of BNP and HRV were determined before treatment and after treatment.. There was no statistical difference in pre-treatment plasma BNP (P > 0.05). Plasma BNP significantly decreased after treatment in the two groups when compared with before treatment (P < 0.05). The decrease was more obvious in the treatment group (P < 0.05). There was no statistical difference in pre-treatment HRV (P > 0.05). Compared with before treatment in the same group, RMSSD, PNN50%, and high frequency (HF) obviously increased, while low frequency (LF) and LF/HF ratio significantly decreased in the two groups, showing statistical difference (P < 0.05). The aforesaid indices were obviously better in the treatment group than in the control group (P < 0.05).. Additional administration of WG could improve short-term clinical prognosis by down-regulating plasma BNP level (via improving myocardial ischemia) and modulating HRV.

Topics: Acute Coronary Syndrome; Adult; Aged; Aged, 80 and over; Drugs, Chinese Herbal; Female; Heart Rate; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Phytotherapy; Prognosis

The predictive value of preoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP) was evaluated in patients with acute coronary syndrome undergoing coronary artery bypass grafting (CABG).. As a substudy to a clinical trial 383 patients with acute coronary syndrome undergoing CABG were studied. 17 patients had a concomitant procedure. NT-proBNP was measured immediately preoperatively and evaluated with regard to in-hospital mortality, and severe circulatory failure postoperatively according to prespecified criteria. Follow-up was 3.2 ± 0.9 years.. In patients with isolated CABG, receiver operating characteristics (ROC) analysis showed an area under the curve (AUC) of 0.82 for in-hospital mortality and 0.87 for severe circulatory failure respectively with a best cut-off for preoperative NT-proBNP of 1028 ng/L. This cut-off level independently predicted severe circulatory failure. Patients with NT-proBNP < 1028 ng/L had significantly better long-term survival (p = 0.004). Preoperative NT-proBNP was higher in patients with concomitant procedure than isolated CABG (2146 ± 1858 v 887 ± 1635 ng/L; p = 0.0005). In patients with concomitant procedure ROC analysis showed an AUC of 0.93 for severe circulatory failure with a best cut-off for preoperative NT-proBNP of 3145 ng/L.. Preoperative NT-proBNP predicted in-hospital mortality, severe circulatory failure postoperatively and long-term survival in patients undergoing surgery for acute coronary syndrome but a higher threshold was found in patients having concomitant procedures.

Topics: Acute Coronary Syndrome; Aged; Aged, 80 and over; Area Under Curve; Biomarkers; Coronary Artery Bypass; Female; Hospital Mortality; Humans; Kaplan-Meier Estimate; Logistic Models; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Preoperative Period; Prospective Studies; Risk Factors; ROC Curve; Shock; Sweden; Time Factors; Treatment Outcome

We evaluated the predictive ability of cystatin C and creatinine-based estimations of glomerular filtration rate (eGFR), including the Chronic Kidney Disease-Epidemiology (CKD-EPI) equation, in acute coronary syndrome (ACS) patients with (STE-ACS) or without (NSTE-ACS) ST elevation in a large contemporary ACS population.. Concentrations of cystatin C and creatinine, as well as eGFR at randomization, were measured in 16 401 patients in the Platelet Inhibition and Patient Outcomes (PLATO) study and evaluated as predictors of the composite end point of cardiovascular death or myocardial infarction within 1 year. Two Cox proportional hazards models were used, the first adjusting for clinical characteristics and the second for clinical characteristics plus the biomarkers N-terminal pro-B-type natriuretic peptide, troponin I, and C-reactive protein.. The median cystatin C value was 0.83 mg/L. Increasing quartiles of cystatin C were strongly associated with poor outcome (6.9%, 7.1%, 9.5%, and 16.2%). The fully adjusted hazard ratios per SD of cystatin C in the NSTE-ACS and STE-ACS populations were 1.12 (95% CI 1.04-1.20) (n=8053) and 1.06 (95% CI 0.97-1.17) (n=5278), respectively. There was no significant relationship of cystatin C with type of ACS (STE or NSTE). c Statistics ranged from 0.6923 (cystatin C) to 0.6941 (CKD-EPI).. Cystatin C concentration contributes independently in predicting the risk of cardiovascular death or myocardial infarction in NSTE-ACS, with no interaction by type of ACS. CKD-EPI exhibited the largest predictive value of all renal markers. Nevertheless, the additive predictive value of cystatin C or creatinine-based eGFR measures in the unselected ACS patient is small.

Topics: Acute Coronary Syndrome; Adenosine; Aged; Biomarkers; C-Reactive Protein; Clopidogrel; Creatinine; Cystatin C; Double-Blind Method; Endpoint Determination; Female; Glomerular Filtration Rate; Humans; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Platelet Aggregation Inhibitors; Predictive Value of Tests; Proportional Hazards Models; Protein Precursors; Ticagrelor; Ticlopidine; Troponin I

To investigate the effects of Chinese herbs for supplementing qi, nourishing yin and activating blood circulation on heart function of patients with acute coronary syndrome (ACS) after successful percutaneous coronary intervention (PCI).. One hundred patients with ACS after successful PCI were randomly assigned to a Western medicine (WM) treatment group (WMG) and a combined treatment group (CMG) treated by Chinese herbs for supplementing qi, nourishing yin and activating blood circulation, besides Western medicine treatment, with 50 cases in each group. Both treatment courses were 6 months. The followup was scheduled at baseline, 6 months and 1 year after PCI, and New York Heart Association (NYHA) functional class, Chinese medicine (CM) symptom scores, blood stasis syndrome scores, and major adverse cardiovascular events (MACE) were observed, serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and hyper-sensitivity C-reactive protein (Hs-CRP) were measured, an echocardiogram was conducted to examine left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), inter-ventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), and ventricular wall motion index (VWMI).. Compared with the baseline, LVEF significantly increased (P<0.01), and CM symptom scores, blood stasis syndrome scores, VWMI, LVEDV, LVESV, NT-proBNP, and Hs-CRP all decreased (P<0.01) in both groups at 6 months and at 1 year after PCI. There were no significant differences in all the above parameters at 1 year vs those at 6 months after PCI (P>0.05). VWMI, LVEDV, LVESV, NT-proBNP, Hs-CRP, LVEF, and CM symptom and blood stasis syndrome scores were all improved obviously in CMG than those in WMG (P<0.05 or P<0.01) at 6 months and at 1 year after PCI. There were no significant differences in NYHA functional class between CMG and WMG at different follow-up timepoints; it was notable that value was 0.054 when comparing the cases of NYHA functional class between the two groups at 1-year follow-up. During the 1-year follow-up, 3 MACE and 11 MACE occurred in CMG and WMG, respectively; the MACE rate in CMG was lower than that in WMG (6% vs 22%, P<0.05).. Chinese herbs for supplementing qi, nourishing yin and activating blood circulation could improve heart function, reduce the CM symptom scores and blood stasis syndrome scores, and decrease the incidence of MACE in patients with ACS after successful PCI.

Topics: Acute Coronary Syndrome; C-Reactive Protein; Cardiotonic Agents; China; Coronary Circulation; Drugs, Chinese Herbal; Female; Heart Function Tests; Humans; Incidence; Male; Middle Aged; Natriuretic Peptide, Brain; New York; Peptide Fragments; Percutaneous Coronary Intervention; Postoperative Complications; Qi; Societies, Medical; Syndrome; Ultrasonography; Yin-Yang

Topics: Acute Coronary Syndrome; Aged; Aged, 80 and over; Cohort Studies; Female; Follow-Up Studies; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Prognosis; Risk Factors; Stroke Volume

Several studies have shown an association between vitamin D deficiency and cardiovascular risk. Vitamin D status is assessed by determination of 25-hydroxyvitamin D [25(OH)D] in serum.. We assessed the prognostic utility of 25(OH)D in 982 chest-pain patients with suspected acute coronary syndrome (ACS) from Salta, Northern Argentina. 2-year follow-up data including all-cause mortality, cardiac death and sudden cardiac death were analyzed in quartiles of 25(OH)D, applying univariate and multivariate analysis.. There were statistically significant changes in seasonal 25(OH)D levels. At follow-up, 119 patients had died. The mean 25(OH)D levels were significantly lower among patients dying than in long-term survivors, both in the total population and in patients with a troponin T (TnT) release (n = 388). When comparing 25(OH)D in the highest quartile to the lowest quartile in a multivariable Cox regression model for all-cause mortality, the hazard ratio (HR) for cardiac death and sudden cardiac death in the total population was 0.37 (95% CI, 0.19-0.73), p = 0.004, 0.23 (95% CI, 0.08-0.67), p = 0.007, and 0.32 (95% CI, 0.11-0.94), p = 0.038, respectively. In patients with TnT release, the respective HR was 0.24 (95% CI, 0.10-0.54), p = 0.001, 0.18 (95% CI, 0.05-0.60), p = 0.006 and 0.25 (95% CI, 0.07-0.89), p = 0.033. 25(OH)D had no prognostic value in patients with no TnT release.. Vitamin D was shown to be a useful biomarker for prediction of mortality when obtained at admission in chest pain patients with suspected ACS.. ClinicalTrials.gov NCT01377402.

Topics: Acute Coronary Syndrome; Aged; Argentina; Body Mass Index; C-Reactive Protein; Cause of Death; Chest Pain; Death, Sudden, Cardiac; Discriminant Analysis; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Natriuretic Peptide, Brain; Proportional Hazards Models; Risk Assessment; ROC Curve; Troponin T; Vitamin D

To investigate growth differentiation factor (GDF)-15 at hospital discharge for assessment of the risk of death, recurrent myocardial infarction (MI), and congestive heart failure, and to determination of whether these risks can be modified by statins.. GDF-15 is a transforming growth factor-β-related cytokine induced in response to tissue injury. GDF-15 concentration is associated with all-cause mortality in patients with acute coronary syndrome (ACS). We measured GDF-15 in 3501 patients after ACS, treated with moderate or intensive statin therapy in PROVE IT-TIMI 22. By using established cutoff points, GDF-15 (<1200, 1200-1800, and >1800 ng/L) was associated with 2-year risk of death or MI (5.7%, 8.1%, and 15.1%, respectively; P<0.001), death (P<0.001), MI (P<0.001), and congestive heart failure (P<0.001). After adjustment for age, sex, body mass index, diabetes mellitus, hypertension, smoking, MI, qualifying event, renal function, B-type natriuretic peptide, and high-sensitivity C-reactive protein, GDF-15 was associated with the risk of death or MI (adjusted hazard ratio per ln increase GDF-15, 2.1 [95% CI, 1.6 to 2.9]; P<0.001), death (P<0.001), MI (P<0.001), and congestive heart failure (P<0.001). There was no significant interaction between GDF-15 and intensive statin therapy for the risk of death or MI (P=0.24 for the interaction).. GDF-15 is associated with recurrent events after ACS, independent of clinical predictors, B-type natriuretic peptide, and high-sensitivity C-reactive protein. This finding supports GDF-15 as a prognostic marker in ACS and investigation of other therapies that modify this risk.

Topics: Acute Coronary Syndrome; Aged; Angina, Unstable; Biomarkers; C-Reactive Protein; Chi-Square Distribution; Europe; Female; Growth Differentiation Factor 15; Heart Failure; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Kaplan-Meier Estimate; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Patient Discharge; Proportional Hazards Models; Recurrence; Risk Assessment; Risk Factors; Stroke; Time Factors; Treatment Outcome; United States

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).. We 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 [HR(adj) 2.71 (P < 0.001) for cTnI ≥0.03 ng/mL; HR(adj) 3.01 (P < 0.001) for NT-proBNP ≥400 pg/mL; HR(adj) 1.45 (P = 0.019) for high-sensitivity (hs) C-reactive protein ≥15 mg/L; and HR(adj) 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.. 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.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; C-Reactive Protein; Cause of Death; Female; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Peroxidase; Prognosis; Risk Factors; Troponin I; Ventricular Dysfunction, Left

Evidence of the clinical benefit of 3-in-1 point-of-care testing (POCT) for cardiac troponin T (cTnT), N-terminal pro-brain natriuretic peptide (NT-proBNP) and D-dimer in cardiovascular risk stratification at primary care level for diagnosing acute coronary syndromes (ACS), heart failure (HF) and thromboembolic events (TE) is very limited. The aim of this study is to analyse the diagnostic accuracy of POCT in primary care.. Prospective multicentre controlled trial cluster-randomised to POCT-assisted diagnosis and conventional diagnosis (controls). Men and women presenting in 68 primary care practices in Zurich County (Switzerland) with chest pain or symptoms of dyspnoea or TE were consecutively included after baseline consultation and working diagnosis. A follow-up visit including confirmed diagnosis was performed to determine the accuracy of the working diagnosis, and comparison of working diagnosis accuracy between the two groups.. The 218 POCT patients and 151 conventional diagnosis controls were mostly similar in characteristics, symptoms and pre-existing diagnoses, but differed in working diagnosis frequencies. However, the follow-up visit showed no statistical intergroup difference in confirmed diagnosis frequencies. Working diagnoses overall were significantly more correct in the POCT group (75.7% vs 59.6%, p = 0.002), as were the working diagnoses of ACS/HF/TE (69.8% vs 45.2%, p = 0.002). All three biomarker tests showed good sensitivity and specificity.. POCT confers substantial benefit in primary care by correctly diagnosing significantly more patients.. DRKS: DRKS00000709.

Topics: Acute Coronary Syndrome; Aged; Aged, 80 and over; Biomarkers; Cluster Analysis; Female; Fibrin Fibrinogen Degradation Products; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Point-of-Care Systems; Primary Health Care; Prospective Studies; Reproducibility of Results; Risk Factors; Thromboembolism; Troponin T

The evaluation of the patient with chest pain in the emergency department is one of the most common situations that the doctor has to face. The diagnostic procedure supposes an observation period of at least 6-12 hours, a well organized medical facilities and the identification of all SCA cases to reduce inappropriate admission.. In our study we have estimated the utility of the marker assay that is associated to the use of risk scores (TIMI and GRACE risk score) to obtain indication about the most appropriate assistance level. In particular, we used the assay of necrosis markers to highlight the damage along with the assay of natriuretic peptides for their role in the diagnosis and in the monitoring of the patients with cardiac damage.. Also PCR has an important role such as marker of plaque stability and of inflammation. These markers associated to the necrosis markers could give important clinical information of independent nature.. The sensibility of laboratory markers, without important necrosis, is low and it is not possible to exclude in a few time a SCA There is now an alternative strategy: a precocious risk stratification. Using clinical criteria it is possible to do a first evaluation of the probability of SCA and the complications.

Topics: Acute Coronary Syndrome; Adult; Aged; Biomarkers; Chest Pain; Creatine Kinase, MB Form; Emergency Service, Hospital; Female; Fibrin Fibrinogen Degradation Products; Humans; Male; Middle Aged; Myoglobin; Natriuretic Peptide, Brain; Point-of-Care Systems; Predictive Value of Tests; Prognosis; Risk; Sensitivity and Specificity; Severity of Illness Index; Troponin I

The aim of this study is to assess the role of novel biomarkers for the diagnostic evaluation of acute coronary syndrome (ACS).. Among 318 patients presenting to an emergency department with acute chest discomfort, we evaluated the diagnostic value of 5 candidate biomarkers (amino terminal pro-B-type natriuretic peptide [NT-proBNP], ischemia modified albumin, heart fatty acid binding protein, high-sensitivity troponin I [hsTnI], and unbound free fatty acids [FFAu]) for detecting ACS, comparing their results with that of conventional troponin T (cTnT).. Sixty-two subjects (19.5%) had ACS. The sensitivity and negative predictive values of NT-proBNP (73%, 90%) and hsTnI (57%, 89%) were higher than that of cTnT (22%, 84%). Unbound free fatty acids had the highest overall combination of sensitivity (75%), specificity (72%), and negative predictive values (92%) of all the markers examined. A significant increase in the C-statistic for cTnT resulted from the addition of results for NT-proBNP (change 0.09, P = .001), hsTnI (change 0.13, P < .001), and FFAu (change 0.15, P < .001). In integrated discrimination improvement and net reclassification improvement analyses, NT-proBNP, hsTnI, and FFAu added significant diagnostic information to cTnT; when changing the diagnostic criterion standard for ACS to hsTnI, FFAu still added significant reclassification for both events and nonevents. In serial sampling (n = 180), FFAu added important reclassification information to hsTnI.. Among emergency department patients with symptoms suggestive of ACS, neither ischemia modified albumin nor heart fatty acid binding protein detected or excluded ACS, whereas NT-proBNP, hsTnI, or FFAu added diagnostic information to cTnT. In the context of hsTnI results, FFAu measurement significantly reclassified both false negatives and false positives at baseline and in serial samples.

Topics: Acute Coronary Syndrome; Albumins; Biomarkers; Chest Pain; Diagnosis, Differential; Emergency Service, Hospital; Fatty Acid-Binding Proteins; Fatty Acids, Nonesterified; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Protein Precursors; Reproducibility of Results; Troponin T

Among patients with non-ST-segment elevation acute coronary syndromes, recurrent ischemia and ventricular arrhythmias detected on continuous electrocardiographic monitoring remain common events that are associated with worse outcomes. The relative clinical significance of both events together is not well described. We determined the risk associated with ischemia (≥1 mm ST depression lasting ≥1 minutes) and ventricular tachycardia (VT) (≥4 beats) detected on 7-day continuous electrocardiographic monitoring in 6,355 patients with non-ST-segment elevation acute coronary syndromes from the Metabolic Efficiency with Ranolazine for Less Ischemia in Non-ST-elevation Acute Coronary Syndrome-Thrombolysis In Myocardial Infarction (MERLIN-TIMI) 36 trial. The patients were categorized into 4 groups according to the presence or absence of VT and ischemia. Cardiovascular death, sudden cardiac death (SCD), myocardial infarction, and recurrent ischemia were assessed during a median follow-up of 348 days. A total of 60.0% patients had no VT or ischemia, 20.0% had VT alone, 14.7% had ischemia alone, and 5.3% had both. The patients with either VT or ischemia were at increased risk of cardiovascular outcomes. The combination of ischemia and VT identified a particularly high-risk population for cardiovascular death (10.1% vs 3.0%, p <0.001), SCD (7.8% vs 0.9%, p <0.001), and myocardial infarction (15.4% vs 6.2%, p <0.001) compared to patients with neither. The addition of arrhythmia and ischemia significantly improved the clinical model for predicting cardiovascular death or SCD (p <0.001). In patients with both ischemia and VT, 66.6% of SCD occurred within 90 days of the non-ST-segment elevation acute coronary syndromes. In conclusion, in >6,300 patients with non-ST-segment elevation acute coronary syndromes, the presence of myocardial ischemia or VT alone, and particularly in combination, was independently associated with poor cardiovascular outcomes and thus provides incremental improvement in early risk stratification.

Topics: Acute Coronary Syndrome; Age Factors; Aged; Arrhythmias, Cardiac; Death, Sudden, Cardiac; Diabetes Mellitus; Electrocardiography, Ambulatory; Female; Heart Failure; Humans; Male; Middle Aged; Myocardial Ischemia; Natriuretic Peptide, Brain; Recurrence; Risk Assessment; Sex Factors; Stroke Volume; Tachycardia, Ventricular; Troponin

Patients undergoing acute left main (LM) coronary artery revascularization have a high mortality and natriuretic peptides such as N-terminal pro-B-type (NT-proBNP) have been shown to have prognostic value in patients with acute coronary syndromes. The present study looked at the prognostic value of NT-proBNP in these patients.. We studied all consecutive patients undergoing acute LM coronary artery percutaneous coronary intervention between January 2005 and December 2008 in whom NT-proBNP was measured (n=71). We analyzed the clinical characteristics and the short- and long-term outcomes in relation to NT-proBNP level at admission. Median NT-proBNP was 1,364 ng/L, ranging from 46 to 70,000 ng/L. NT-proBNP was elevated in 63 (89%) patients and was ≥1,000ng/L in 42 (59%). Log NT-proBNP (hazard ratio [HR] 3.51, 95% confidence interval [CI] 1.55-7.97, P=0.003) and left ventricular ejection fraction (HR 0.95, 95%CI 0.91-0.99, P=0.007) were predictors for all-cause mortality. Log NT-proBNP was the only independent significant predictor of cardiovascular mortality. In-hospital mortality was 0% for patients with NT-proBNP <1,000, but 17% for those with NT-proBNP ≥1,000 (P=0.036).. NT-proBNP is a strong predictor of outcome in patients undergoing acute LM coronary artery stenting. Mortality in such patients is high, but those with NT-proBNP < 1,000ng/L may have a favorable short- and long-term prognosis. Further research, including a larger patient population, is needed to determine the optimal cut-off value for NT-proBNP in patients undergoing acute LM coronary artery intervention.

Topics: Acute Coronary Syndrome; Aged; Aged, 80 and over; Angioplasty, Balloon, Coronary; Biomarkers; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Survival Rate; Time Factors

We designed a prospective evaluation of the interaction between B-type natriuretic peptide (BNP) and the effect of ranolazine in patients with acute coronary syndromes (ACS) as part of a randomized, blinded, placebo-controlled trial.. Ranolazine is believed to exert anti-ischemic effects by reducing myocardial sodium and calcium overload and consequently ventricular wall stress. BNP increases in response to increased wall stress and is a strong risk indicator in ACS.. We measured plasma BNP in all available baseline samples (n = 4,543) among patients with non-ST-segment elevation ACS randomized to ranolazine or placebo in the MERLIN-TIMI 36 (Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST Elevation Acute Coronary-Thrombolysis In Myocardial Infarction 36) trial and followed them for a mean of 343 days. The primary end point was a composite of cardiovascular death, myocardial infarction, and recurrent ischemia. BNP elevation was defined as >80 pg/ml.. Patients with elevated BNP (n = 1,935) were at significantly higher risk of the primary trial end point (26.4% vs. 20.4%, p < 0.0001), cardiovascular death (8.0% vs. 2.1%, p < 0.001), and myocardial infarction (10.6% vs. 5.8%, p < 0.001) at 1 year. In patients with BNP >80 pg/ml, ranolazine reduced the primary end point (hazard ratio [HR]: 0.79; 95% confidence interval [CI]: 0.66 to 0.94, p = 0.009). The effect of ranolazine in patients with BNP >80 pg/ml was directionally similar for recurrent ischemia (HR: 0.78; 95% CI: 0.62 to 0.98; p = 0.04) and cardiovascular death or myocardial infarction (HR: 0.83; 95% CI: 0.66 to 1.05, p = 0.12). There was no detectable effect in those with low BNP (p interaction value = 0.05).. Our findings indicate that ranolazine may have enhanced efficacy in high-risk patients with ACS identified by increased BNP. The interaction of biomarkers of hemodynamic stress and the effects of ranolazine warrants additional investigation. (Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST Elevation Acute Coronary Syndromes; NCT00099788).

Topics: Acetanilides; Acute Coronary Syndrome; Aged; Biomarkers; Double-Blind Method; Enzyme Inhibitors; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Piperazines; Ranolazine; Risk Factors

Elevated natriuretic peptides (NPs) are associated with an increased cardiovascular risk following acute coronary syndromes (ACSs). However, the therapeutic implications are still undefined. We hypothesized that early inhibition of renin-angiotensin-aldosterone system (RAAS) in patients with preserved left ventricular function but elevated NPs but following ACS would reduce haemodynamic stress as reflected by a greater reduction NP compared with placebo.. AVANT GARDE-TIMI 43 trial, a multinational, double-blind trial, randomized 1101 patients stabilized after ACS without clinical evidence of heart failure or left ventricular function

Topics: Acute Coronary Syndrome; Aged; Amides; Analysis of Variance; Angiotensin II Type 1 Receptor Blockers; Blood Pressure; Death, Sudden, Cardiac; Double-Blind Method; Female; Fumarates; Hospitalization; Humans; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Renin; Renin-Angiotensin System; Tetrazoles; Valine; Valsartan

The diagnosis of cardiac necrosis such as myocardial infarction can be difficult and relies on the use of circulating protein markers like troponin. However, there is a clear need to identify circulating, specific biomarkers that can detect cardiac ischemia without necrosis.. Using specific immunoassay and tandem mass spectrometry, we show that a fragment derived from the signal peptide of B-type natriuretic peptide (BNPsp) not only is detectable in cytosolic extracts of explant human heart tissue but also is secreted from the heart into the circulation of healthy individuals. Furthermore, plasma levels of BNPsp in patients with documented acute ST-elevation myocardial infarction (n=25) rise to peak values ( approximately 3 times higher than the 99th percentile of the normal range) significantly earlier than the currently used biomarkers myoglobin, creatine kinase-MB, and troponin. Preliminary receiver-operating characteristic curve analysis comparing BNPsp concentrations in ST-elevation myocardial infarction patients and other patient groups was positive (area under the curve=0.97; P<0.001), suggesting that further, more rigorous studies in heterogeneous chest pain patient cohorts are warranted.. Our results demonstrate for the first time that BNPsp exists as a distinct entity in the human circulation and could serve as a new class of circulating biomarker with the potential to accelerate the clinical diagnosis of cardiac ischemia and myocardial infarction. Clinical Trial Registration- URL: http://www.anzctr.org.au. Unique identifier: ACTRN12609000040268.

Topics: Acute Coronary Syndrome; Biomarkers; Chest Pain; Electrocardiography; Humans; Immunoassay; Myocardial Ischemia; Myocardium; Natriuretic Peptide, Brain; Tandem Mass Spectrometry

The aim of this research was to describe N-terminal part of the prohormone B-type natriuretic peptide (NT-proBNP) levels over time in patients with acute coronary syndrome (ACS) before and after percutaneous coronary intervention (PCI). NT-proBNP, troponin I (Tn-I), creatine kinase (CK), CK MB isoenzyme (CKMB), fibrinogen, D-dimers, and C-reactive protein (CRP) were measured in 300 consecutive patients with ACS before undergoing successful reperfusion with PCI in the first 48 hours, 2 days after, and at the end of the 1st, 3rd, 6th, 12th, 18th, and 24th month. The concentration of NT-proBNP was cross-correlated with the levels of NT-proBNP in 300 patients without ACS and was significantly increased before and after PCI and at the end of the 3rd month, contrasting with the fast conversion to normal levels of Tn-I, CK, CKMB, fibrinogen, D-dimers, and CRP. In patients with ACS undergoing successful PCI, NT-proBNP shows slow kinetics, especially in patients with an increased thrombolysis in myocardial infarction risk score, hypertension, and diabetes. Nevertheless, cardiac neurohormonal activation may be a unifying feature among patients at high risk for cardiovascular events after ACS and PCI.

Topics: Acute Coronary Syndrome; Acute-Phase Proteins; Aged; Angioplasty, Balloon, Coronary; Biomarkers; Creatine Kinase, MB Form; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Reproducibility of Results; Risk Assessment; Thrombolytic Therapy; Time Factors; Troponin I

Heart failure (HF) is an important cause of morbidity in patients with acute coronary syndromes (ACS). C-reactive protein (CRP) has been implicated in experimental models as exacerbating myocardial injury, but data regarding the clinical relationship of high-sensitivity CRP (hsCRP) and B-type natriuretic peptide (BNP) concentrations with the risk of HF after ACS are few.. PROVE IT-TIMI 22 randomized 4162 patients who had been stabilized after ACS to either intensive or moderate statin therapy. hsCRP and BNP were measured 30 days after randomization. Hospitalizations for HF and cardiovascular death occurring after day 30 were assessed for a mean follow-up of 24 months.. Patients who developed HF had higher concentrations of hsCRP (3.7 mg/L vs 1.9 mg/L, P < 0.001) and BNP (59 ng/L vs 22 ng/L, P < 0.0001). HF increased in a stepwise manner with hsCRP quartile [adjusted hazard ratio (HR(adj)) for Q4 vs Q1, 2.5; P = 0.01] and BNP quartile (HR(adj) for Q4 vs Q1, 5.8; P < 0.001), with similar results obtained for HF and cardiovascular death. In a multivariable analysis, higher concentrations of hsCRP and BNP were both independently associated with HF [HR(adj), 1.9 for hsCRP >2.0 mg/L (P = 0.01) and 4.2 for BNP >80 ng/L (P < 0.001)]. Patients with increases in both markers were at the greatest risk of HF, compared with patients without an increased marker concentration (HR(adj), 8.3; P = 0.01). The benefit of intensive statin therapy in reducing HF was consistent among all patients, regardless of hsCRP or BNP concentration.. Both hsCRP and BNP measured 30 days after ACS are independently associated with the risk of HF and cardiovascular death, with the greatest risk occurring when both markers are increased.

Topics: Acute Coronary Syndrome; Biomarkers; C-Reactive Protein; Double-Blind Method; Evidence-Based Medicine; Heart Failure; Hospitalization; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Kaplan-Meier Estimate; Multivariate Analysis; Natriuretic Peptide, Brain; Predictive Value of Tests; Proportional Hazards Models; Risk

While preprocedural statin treatment for acute coronary syndrome (ACS) is widely regarded as beneficial, there has been no prospective randomized multicenter trial of patients with non-ST elevation ACS in the Japanese population to examine the efficacy of preprocedural aggressive statin use. The aim of this study was to confirm this effect by prospective randomized multicenter design.. Fifty patients who presented with non-ST elevation ACS were enrolled, and randomly assigned to aggressive statin administration before percutaneous coronary intervention (PCI). Troponin-T (TnT), creatine phosphokinase (CK), CK-myocardial band (CK-MB), high-sense C-reactive protein (hs-CRP), and brain natriuretic peptide (BNP) were measured at baseline and/ or after procedure.. Three days after PCI, the statin group had significantly less CK elevation compared with the nonstatin group (84+/-17 IU/l versus 180+/-68 IU/l, respectively, p = 0.02). CK-MB elevation also tended to be lower in the statin group than in the nonstatin group (3.2+/-1.9 versus. 7.0+/-3.0, respectively, p = 0.07), as was BNP level (3.2+/-1.9 versus 7.0+/-3.0 pg/ml, respectively, p = 0.07). The change of serum LDL cholesterol was significantly correlated with CK (p = 0.01) and TnT (p = 0.02) at 1 day after PCI.. Aggressive statin usage before PCI to Japanese patients with non-ST elevation ACS appears to reduce myocardial damage after procedure. The degree of serum lipid level reduction may reflect the vulnerability of atheromatous plaques that could cause cardiac damage after PCI.

Topics: Acute Coronary Syndrome; Aged; Aged, 80 and over; Angioplasty, Balloon, Coronary; Biomarkers; Cholesterol, LDL; Creatine Kinase; Creatine Kinase, MB Form; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Japan; Male; Middle Aged; Myocardial Infarction; Myocardium; Natriuretic Peptide, Brain; Prospective Studies; Time Factors; Treatment Outcome; Troponin T

There is limited information about the in-hospital plasma profile of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with non-ST-elevation acute coronary syndrome (NSTACS) and furthermore, the prognostic influence of the timing of NT-proBNP measurements in NSTACS is unsettled. These subject matters are elucidated in this study composed of 455 patients with NSTACS (symptoms <24 h). NT-proBNP was measured at 0, 6, 12, 24, 36, 48, 72 and 96 h following admission. Any death was registered at follow-up (median: 2.3 years). The study demonstrated a monophasic profile of the plasma NT-proBNP values, reaching a maximum at 6 hours, and it showed an independent prognostic significance of NT-proBNP irrespective of the sampling time. Risk prediction by NT-proBNP was improved by combining the baseline measurement and one value taken between 24 and 96 h (at 48 h, P<0.001). No additional prognostic information was provided by including more than one late in-hospital NT-proBNP value.. The in-hospital NT-proBNP measurements exhibit a monophasic profile in patients with NSTACS and these values provide independent prognostic information as regards mortality irrespective of the sampling time. Moreover, risk prediction of NT-proBNP is strengthened by combining the admission measurement with an additional value during the hospitalization.

Topics: Acute Coronary Syndrome; Aged; Electrocardiography; Female; Hospitalization; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Risk Assessment; Troponin T

Recently, a high prevalence of small persistent cardiac troponin I (cTnI) elevations has been reported in patients who had been stabilized after a recent episode of acute coronary syndrome (ACS). We now have studied the associations of persistently elevated cTnI levels to cardiac performance, inflammation, coagulation, coronary status, and treatment strategy in these patients.. Cardiac troponin I was determined at 6 weeks, 3 months, and 6 months after randomization in 898 stabilized ACS patients from the FRagmin and Fast Revascularization during InStability in Coronary artery disease (FRISC) II trial and using the high-sensitive Access AccuTnI assay (Beckman Coulter, Fullerton, CA). All patients were followed up for at least 5 years. Persistent cTnI elevation >0.01 microg/L at the 3 measurement instances was detected in 233 patients (26%). N-terminal pro-brain natriuretic peptide (NT-proBNP) at 6 months (OR 2.5, 95% CI 2.0-3.1), male sex (OR 2.2, 95% CI 1.4-3.7), and randomization to an early invasive strategy (OR 1.8, 95% CI 1.2-2.7) independently predicted persistently elevated cTnI levels. Persistently cTnI-positive patients in the invasive cohort had significantly lower NT-proBNP levels compared to noninvasively treated patients, indicating that the mechanisms causing cTnI elevation in this group may be prognostically less harmful. No independent associations were found for markers of inflammation or coagulation.. Persistent cTnI elevation occurs frequently late after an ACS. The NT-proBNP level at 6 months was the strongest predictor for elevated cTnI levels that thus appear to be predominantly related to impaired left ventricular function.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Dalteparin; Echocardiography; Female; Fibrinolytic Agents; Heart; Humans; Male; Middle Aged; Myocardial Revascularization; Myocardium; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Stroke Volume; Time Factors; Troponin I; Up-Regulation; Ventricular Function, Left

We investigated the prognostic performance of myeloperoxidase (MPO), and soluble CD40 ligand (sCD40L) along with B-type natriuretic peptide (BNP), high-sensitivity C-reactive protein (hsCRP), and cardiac troponin I (cTnI) for non-fatal recurrent ischaemic events in non-ST elevation acute coronary syndrome (ACS).. We measured plasma MPO and sCD40L in 1524 patients with ACS treated with tirofiban and randomized to early invasive vs. conservative management in the TACTICS-TIMI 18 trial who survived to 180 days. Patients with elevated baseline MPO (>884 pM) were at higher risk of non-fatal myocardial infarction or rehospitalization for ACS at 30 days (9.3 vs. 4.6%, P < 0.001). In contrast, no difference was observed with higher sCD40L (>989 pg/mL, 7.6 vs. 6.3%, P = 0.31). MPO remained associated with recurrent ischaemic events after adjustment for age, ST-deviation, diabetes, prior coronary artery disease, heart failure, cTnI, hsCRP, and sCD40L (OR 2.10; 95% CI 1.36-3.23, P = 0.001). This association was attenuated by 180 days (OR 1.26; 0.95-1.68). Stratification using baseline MPO, BNP, and cTnI identified a >3-fold gradient of risk.. MPO adds to BNP and cTnI for short-term risk assessment for recurrent ischaemic events in non-ST elevation ACS. sCD40L was not associated with risk in this population treated with a platelet GPIIb/IIIa receptor antagonist.

Topics: Acute Coronary Syndrome; Aged; Angina, Unstable; Biomarkers; C-Reactive Protein; CD40 Ligand; Creatine Kinase, MB Form; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peroxidase; Platelet Glycoprotein GPIIb-IIIa Complex; Predictive Value of Tests; Prognosis; Recurrence; Risk Assessment; Troponin I

Numerous markers have been identified as useful predictors of major adverse cardiac events (MACE) in patients with suspected acute coronary syndrome (ACS). However, only little is known about the relative benefit of the single markers in risk stratification and the best combination for optimising prognostic power. The aim of the present study was to define the role of the emerging cardiovascular risk marker lipoprotein-associated phospholipase A2 (Lp-PLA2) in a multi-marker approach in combination with troponin I (TnI), NT-proBNP, high sensitivity (hs)CRP, and D-dimer in patients with ACS.. A total of 429 consecutive patients (age 60.5+/-14.1 years, 60.6% male) who were admitted to the emergency room with suspected ACS were analysed in the study. Biochemical markers were measured by immunoassay techniques. All patients underwent point-of-care TnI testing and early coronary angiography if appropriate, in accordance with the current guidelines. Classification and regression trees (CART) and logistic regression techniques were employed to determine the relative predictive power of markers for the primary end-point defined as any of the following events within 42 days after admission: death, non-fatal myocardial infarction, unstable AP requiring admission, admission for decompensated heart failure or shock, percutaneous coronary intervention, coronary artery bypass grafting, life threatening arrhythmias or resuscitation. The incidence of the primary end-point was 13.1%, suggesting a mild to moderate risk population. The best overall risk stratification was obtained using NT-proBNP at a cut-off of 5000 pg/mL (incidence of 40% versus 10.3%, relative risk (RR) 3.9 (95% CI 2.4-6.3)). In the remaining lower risk group with an incidence of 10.3%, further separation was performed using TnI (cut-off 0.14 microg/L; RR=3.1 (95% CI 1.7-5.5) 23.2% versus 7.5%) and again NT-proBNP (at a cut-off of 140 ng/L) in patients with negative TnI (RR=3.2 (95% CI 1.3-7.9), 11.7% versus 3.6%). A final significant stratification in patients with moderately elevated NT-proBNP levels was achieved using Lp-PLA2 at a cut-off of 210 microg/L) (17.9% versus 6.9%; RR=2.6 (95% CI 1.1-6.6)). None of the clinical or ECG variables of the TIMI (Thrombolysis In Myocardial Infarction) risk score provided comparable clinically relevant information for risk stratification.. In the setting of stateof- the-art coronary care for patients with suspected ACS in the emergency room, NT-proBNP, troponin I, and Lp-PLA2 are effective independent markers for risk stratification that proved to be superior to the TIMI risk score. Lp-PLA2 turned out to be a more effective risk marker than hsCRP in these patients.

Topics: 1-Alkyl-2-acetylglycerophosphocholine Esterase; Acute Coronary Syndrome; Aged; Biomarkers; C-Reactive Protein; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Risk Assessment; Risk Factors; Troponin I

Low-dose continuous human atrial natriuretic peptide (hANP) administration during cardiac surgery has been reported on previously. In the present study, the efficacy of the therapy during emergent coronary artery bypass grafting (CABG) for acute coronary syndrome (ACS) is investigated.. One hundred and twenty-four patients patients undergoing emergent CABG for ACS were divided into 2 groups; a group receiving administration of hANP (hANP group) and a group not receiving hANP infusion (non-hANP group). The postoperative peak levels of creatine kinase-MB were significantly lower in the hANP group as compared with those in the non-hANP group. The incidence of postoperative arrhythmias was also significantly lower in the hANP group as compared with that in the non-hANP group. The postoperative brain natriuretic peptide was significantly lower in the hANP group as compared with that in the non-hANP group until 1 year after the operation. The free-rate of cardiac events after the operation was also significantly higher in the hANP group as compared with that in the non-hANP group.. It is therefore considered that hANP might not only be effective for overcoming some major shortcomings of cardiopulmonary bypass, but also might be effective to attenuate ischemia-reperfusion injury, protect the myocardium, have an anti-arrhythmic effect, and suppress left ventricular remodeling.

Topics: Acute Coronary Syndrome; Aged; Arrhythmias, Cardiac; Atrial Natriuretic Factor; Cardiopulmonary Bypass; Coronary Artery Bypass; Emergency Service, Hospital; Female; Humans; Male; Middle Aged; Myocardial Reperfusion Injury; Natriuretic Peptide, Brain; Ventricular Remodeling

The Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS) was established to investigate the drivers of secondary events after first-time acute coronary syndrome (ACS), including addressing inequitable outcomes by ethnicity. Herein, the first clinical outcomes and prognostic modelling approach are reported.. First, in 28 176 New Zealanders with first-time ACS from a national registry, a clinical summary score for predicting 1-year death/cardiovascular readmission was created using Cox regression of 20 clinical variables. This score was then calculated in the 2015 participant MENZACS study to represent clinical risk. In MENZACS, Cox regression was used to assess N-terminal pro-B-type natriuretic peptide (NT-proBNP) as a prognostic marker for death/cardiovascular readmission in four models, adjusting for (1) age and sex; (2) age, sex, ethnicity; (3) clinical summary score; (4) clinical summary score and ethnicity.. In 2015 patients with first-time ACS, recurrent events were common (20.8%). Increasing NT-proBNP levels and Māori ethnicity were predictors of death/cardiovascular readmission, but not after adjustment for the 20 clinical risk factors represented by the clinical summary score.. ACTRN12615000676516.

Topics: Acute Coronary Syndrome; Biomarkers; Female; Humans; Male; Maori People; Middle Aged; Natriuretic Peptide, Brain; New Zealand; Peptide Fragments; Prognosis; Risk Assessment; Risk Factors

To examine the joint association of diabetes status and N-terminal pro-B-type natriuretic peptide (NT-proBNP) with subsequent risk of major adverse cardio-cerebral events (MACCEs) and all-cause mortality in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).. A total of 7956 NSTE-ACS patients recruited from the Cardiovascular Center Beijing Friendship Hospital Database Bank were included in this cohort study. Patients were divided into nine groups according to diabetes status (normoglycemia, prediabetes, diabetes) and NT-proBNP tertiles (< 92 pg/ml, 92-335 pg/ml, ≥ 336 pg/ml). Multivariable Cox proportional hazards models were used to estimate the individual and joint association of diabetes status and NT-proBNP with the risk of MACCEs and all-cause mortality.. During 20,257.9 person-years of follow-up, 1070 MACCEs were documented. In the fully adjusted model, diabetes and a higher level of NT-proBNP were independently associated with MACCEs risk (HR 1.42, 95% CI: 1.20-1.68; HR 1.72, 95% CI: 1.40-2.11) and all-cause mortality (HR 1.37, 95% CI: 1.05-1.78; HR 2.80, 95% CI: 1.89-4.17). Compared with patients with normoglycemia and NT-proBNP < 92 pg/ml, the strongest numerical adjusted hazards for MACCEs and all-cause mortality were observed in patients with diabetes and NT-proBNP ≥ 336 pg/ml (HR 2.67, 95% CI: 1.83-3.89; HR 2.98, 95% CI: 1.48-6.00). The association between MACCEs and all-cause mortality with various combinations of NT-proBNP level, HbA1c, and fasting plasma glucose was studied.. Diabetes status and elevated NT-proBNP were independently and jointly associated with MACCEs and all-cause mortality in patients with NSTE-ACS.

Topics: Acute Coronary Syndrome; Cohort Studies; Diabetes Mellitus; Humans; Natriuretic Peptide, Brain; Prospective Studies

Evidence regarding the role of serial measurements of biomarkers for risk assessment in post-acute coronary syndrome (ACS) patients is limited. The aim was to explore the prognostic value of four, serially measured biomarkers in a large, real-world cohort of post-ACS patients.. BIOMArCS is a prospective, multi-centre, observational study in 844 post-ACS patients in whom 12 218 blood samples (median 17 per patient) were obtained during 1-year follow-up. The longitudinal patterns of high-sensitivity cardiac troponin T (hs-cTnT), N-terminal-pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP), and growth differentiation factor 15 (GDF-15) were analysed in relation to the primary endpoint (PE) of cardiovascular mortality and recurrent ACS using multivariable joint models. Median age was 63 years, 78% were men and the PE was reached by 45 patients. The average biomarker levels were systematically higher in PE compared with PE-free patients. After adjustment for 6-month post-discharge Global Registry of Acute Coronary Events score, 1 standard deviation increase in log[hs-cTnT] was associated with a 61% increased risk of the PE [hazard ratio (HR) 1.61, 95% confidence interval (CI) 1.02-2.44, P = 0.045], while for log[GDF-15] this was 81% (HR 1.81, 95% CI 1.28-2.70, P = 0.001). These associations remained significant after multivariable adjustment, while NT-proBNP and hs-CRP were not. Furthermore, GDF-15 level showed an increasing trend prior to the PE (Structured Graphical Abstract).. Longitudinally measured hs-cTnT and GDF-15 concentrations provide prognostic value in the risk assessment of clinically stabilized patients post-ACS.. The Netherlands Trial Register. Currently available at URL https://trialsearch.who.int/; Unique Identifiers: NTR1698 and NTR1106.

Topics: Acute Coronary Syndrome; Aftercare; Biomarkers; C-Reactive Protein; Female; Growth Differentiation Factor 15; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Patient Discharge; Peptide Fragments; Prognosis; Prospective Studies; Risk Assessment; Troponin T

It is important to identify patients with co-morbid acute coronary syndrome (ACS) and atrial fibrillation (AF) at high risk and adopt proper management strategies to improve their prognosis.. The addition of N-terminal pro-B-type natriuretic peptide (NT-proBNP) could improve predictive value for long-term cardiovascular events beyond the CHA. A total of 1223 patients with baseline NT-proBNP between January 2016 and December 2019 were included in the study. The primary endpoint was all-cause death at 12 months. The secondary outcomes included 12-month cardiac death and major adverse cardiovascular and cerebrovascular event (MACCE), defined as a composite of all-cause death, myocardial infarction, or stroke.. A higher serum of NT-proBNP levels was strongly associated with increased risks of all-cause death (adjusted hazard ratio [HR]: 1.05, 95% confidence interval [CI], 1.03-1.07), cardiac death (adjusted HR: 1.05, 95% CI, 1.03-1.07), and MACCE (adjusted HR: 1.04, 95% CI, 1.02-1.06). The prognostic accuracy of the CHA. In patients with ACS and AF, NT-proBNP is a potential biomarker to enhance risk discrimination for all-cause death, cardiac death, and MACCE in combination with the CHA

Topics: Acute Coronary Syndrome; Atrial Fibrillation; Death; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Risk Assessment; Risk Factors; Stroke

Elevated triglyceride-glucose (TyG) index and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are independently associated with increased risk of major adverse cardio-cerebral events (MACCEs) in diabetic patients with the acute coronary syndrome (ACS), but have not been evaluated jointly. We sought to investigate the independent and joint association of the TyG index and NT-proBNP with MACCEs risk.. Data from 5046 patients with diabetes and ACS were recorded in the Cardiovascular Center Beijing Friendship Hospital Database Bank between 2013 and 2021, including measurements of fasting triglycerides, plasma glucose, and NT-proBNP. The TyG index was calculated as Ln (fasting triglycerides [mg/dL] × fasting plasma glucose [mg/dL]/2). Associations of the TyG index and NT-proBNP with MACCEs risk were assessed using flexible parametric survival models.. During 13589.9 person-years of follow-up, 985 incident MACCEs of the 5046 patients (65.6 years of age and 62.0% men) were observed. Elevated TyG index (HR: 1.18; 95% CI 1.05‒1.32 per 1 unit increase) and NT-proBNP categories (HR: 1.95; 95% CI: 1.50‒2.54 for > 729 pg/ml compared to < 129 pg/ml) were independently associated with MACCEs risk in the fully adjusted model. According to the joint categories of the TyG index and NT-proBNP, patients with the TyG index > 9.336 and NT-proBNP > 729 pg/ml were at the highest risk of MACCEs (HR: 2.45; 95% CI 1.64‒3.65) than the ones with TyG index < 8.746 and NT-proBNP < 129 pg/ml. The test for interaction was not significant (P. The TyG index and NT-proBNP were independently and jointly associated with the risk of MACCEs in patients with diabetes and ACS, suggesting that patients with both markers elevated should be aware of the higher risk in the future.

Topics: Acute Coronary Syndrome; Biomarkers; Blood Glucose; Diabetes Mellitus; Female; Glucose; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Prospective Studies; Risk Assessment; Risk Factors; Triglycerides

Retinol binding protein 4 (RBP4) has been implicated in the progression of cardiovascular diseases. However, its association with major adverse cardiovascular events (MACEs) in patients with acute coronary syndrome (ACS) remains obscure.. Here, we examined the prognostic value of baseline RBP4 and its derived multimarker score for MACEs in ACS patients.. A total of 826 patients with ACS were consecutively recruited from the department of cardiology and prospectively followed up for a median of 1.95 years (interquartile range, 1.02-3.25 years). Plasma RBP4 was measured using enzyme-linked immunosorbent assay. Adjusted associations between RBP4 and its derived multimarker score (1 point was assigned when RBP4 ≥ 38.18μg/mL, left ventricular ejection fraction [LVEF] ≤ 55%, N-terminal pro-B-type natriuretic peptide [NT-proBNP] ≥ 450 ng/L, estimated glomerular filtration rate [eGFR] ≤ 90 mL/min/1.73 m2, and age ≥60) with MACEs were analyzed.. In total, 269 ACS patients (32.57%) experienced MACEs. When patients were grouped by multimarker score (0-1, n = 315; 2-3, n = 406; 4-5, n = 105), there was a significant graded association between RBP4-based multimarker score and risk of MACEs (intermediate score (2-3): HRadj: 1.80; 95% CI, 1.34-2.41; high score (4-5): HRadj: 3.26; 95% CI, 2.21-4.81) and its components (P < .05 for each). Moreover, the prognostic and discriminative value of the RBP4-derived multimarker score remained robust in ACS patients with various high-risk anatomical or clinical characteristics.. The RBP4-derived 5-item score serves as a useful risk stratification and decision support for secondary prevention in patients with ACS.

Topics: Acute Coronary Syndrome; Biomarkers; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Retinol-Binding Proteins, Plasma; Risk Assessment; Stroke Volume; Ventricular Function, Left

In addition to the classical actions of hemodynamic regulation, natriuretic peptides (NPs) interact with various neurohumoral factors that are deeply involved in the pathophysiology of cardiovascular diseases. However, their effects on the hypothalamic-pituitary-adrenal (HPA) axis, which is activated under acute high-stress conditions in acute coronary syndrome (ACS), remain largely unknown. We investigated the impact of plasma B-type NP (BNP) on plasma adrenocorticotropic hormone (ACTH)-cortisol levels during the acute phase of ACS ischemic attacks. The study population included 436 consecutive patients with ACS for whom data were collected during emergency cardiac catheterization. Among them, biochemical data after acute-phase treatment were available in 320 cases, defined as the ACS-remission phase (ACS-rem). Multiple regression analyses revealed that plasma BNP levels were significantly negatively associated with plasma ACTH levels only during ACS attacks (

Topics: Acute Coronary Syndrome; Adrenocorticotropic Hormone; Humans; Hydrocortisone; Hypothalamo-Hypophyseal System; Natriuretic Peptide, Brain; Peptide Hormones; Pituitary-Adrenal System

Patients undergoing successful percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS) with normal left ventricular ejection fraction (LVEF) are generally considered to have successful clinical outcomes; however, there are still significant differences in clinical outcomes among these patients. The aim of the study was to find a common indicator to predict the risk of major adverse cardiac and cerebrovascular events (MACCE) in this population.. A total of 3986 patients with ACS were divided into 4 groups based on the quartile (Q) values of peak N-Terminal pro-brain natriuretic peptide (NT-proBNP) measured during hospitalization. The incidence of MACCE was compared among Q1-Q4 groups during follow up. Multivariate Cox regression analysis was performed to identify independent prognostic factors of MACCE. Receiver operating characteristic (ROC) curve was generated to compare the area under the curve (AUC) for MACCE by adding NT-proBNP to the Thrombolysis in Myocardial Infarction (TIMI) risk score.. NT-proBNP was significantly positively correlated with peak values of cardiac troponin I (cTnI) (r = 0.418), high-sensitivity C-reactive protein (hs-CRP) (r = 0.397) and left ventricular end-diastolic diameter (LVEDD) (r = 0.075) (P < 0.001). The risks of composite MACCE (5.6%, 9.1%, 13.0%, 20.1%, P < 0.001), all-cause death (1.0%, 2.5%, 4.1%, 8.4%, P < 0.001) and non-fatal myocardial infarction (2.0%, 3.4%, 4.8%, 6.2%, P < 0.001) were significantly higher in the higher Q groups. In multivariate analysis, the Q4 group displayed an independent 2.2-fold increase for MACCE compared to Q1 (HR: 2.16; 95%CI: 1.57-2.99; P < 0.001). Compared with TIMI risk score alone, TIMI+NT-proBNP showed improved AUCs: cardiovascular death (P = 0.0008), and heart failure requiring hospitalization (P = 0.0017).. In patients with ACS with successful PCI and normal LVEF, elevated NT-proBNP was significantly associated with poor clinical outcomes. These results suggest that NT-proBNP is a useful biomarker for prognosis and risk stratification in this population.

Topics: Acute Coronary Syndrome; Biomarkers; Humans; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Percutaneous Coronary Intervention; Prognosis; Stroke Volume; Ventricular Function, Left

The aim: To determine the diagnostic value of serum levels of ST2 in patients with the acute coronary syndrome (ACS) and its correlation with NT-proBNP levels.. Materials and methods: NT-proBNP and ST2 concentration in serum of patients was measured on admission to the hospital and on the 10th day of the treatment using NT-proBNP ELISA (Biomedica, Slovakia) and Presage ST2 assay (Critical Diagnostics, USA), respectively.. Results: Statistically significant direct correlations (p<0.05). The simultaneous increase of ST2 and NT-proBNP serum levels above their threshold in patients with ACSelST (sensitivity - 92.5 %, specificity - 74.2 %, AUC - 0.893, р<0.05) indicated a significant risk of cardiovascular (CV) complications of acute myocardial infarction (AMI) during the inpatient period, e.g. acute heart failure, acute LV aneurysm, recurrent AMI, as well as rhythm and conductivity disturbances.. Conclusions: The data suggest that both ST2 and NT-proBNP may prove useful in predicting unfavorable prognosis during the inpatient care of AMI, as the simultaneous increase of these biomarkers above their threshold values indicates a significant risk of CV complications.

Topics: Acute Coronary Syndrome; Biomarkers; Humans; Interleukin-1 Receptor-Like 1 Protein; Natriuretic Peptide, Brain; Peptide Fragments

There are many detectable changes in circulating biomarkers in the setting of myocardial ischemia. We hypothesize that there are associated changes in circulating B-type natriuretic peptide (BNP) level after stress-induced myocardial ischemia, which can be used for emergency department (ED) acute coronary syndrome (ACS) risk stratification.. In a prospective study, we enrolled 340 patients over the age of 30 receiving an exercise echocardiography stress test in an ED observational unit for suspected ACS. We collected blood samples at baseline and at 2 and 4 h post-stress test, measuring the relative and absolute changes (stress-delta) in plasma BNP concentrations. In addition, patients were contacted at 90 days and at 1 year posttest for a follow-up. We calculated the diagnostic test characteristics of stress-delta BNP for a composite outcome of ischemic imaging on stress echocardiogram, nonelective percutaneous coronary intervention, coronary artery bypass graft surgery, subsequent acute myocardial infarction, or cardiac death at 1 year via a logistic regression. We analyzed the 2-h BNP concentrations using an ANOVA model to adjust for the baseline BNP level.. Baseline and 2-h post-stress BNP were both higher in the positive outcome group, but the stress-delta BNP was not. Stress-delta BNP had a sensitivity and specificity, respectively, of 53% and 76% at 2 h and 67% and 68% at 4 h. It was noted that patients with the composite outcome had a higher baseline BNP level.. BNP stress-deltas are poor diagnostic means for ACS risk stratification, but resting BNP remains a promising prognostic tool for ED patients with suspected ACS.

Topics: Acute Coronary Syndrome; Coronary Artery Disease; Emergency Service, Hospital; Humans; Myocardial Infarction; Myocardial Ischemia; Natriuretic Peptide, Brain; Prospective Studies

The aim of this study was to create a risk scoring model to differentiate obstructive coronary artery (CA) from CA spasm in the etioology of acute coronary syndrome (ACS).Methods and Results: We included 753 consecutive patients with ACS without persistent ST-segment elevation (p-STE). The exclusion criteria were: (1) out-of-hospital cardiac arrest; (2) cardiogenic shock; (3) hemodialysis; (4) atrial fibrillation/flutter; (5) severe valvular disease; (6) no coronary angiography; (7) non-obstructive coronary artery without "definite" vasospastic angina definition; and/or (8) missing data. From the multivariate logistic regression analysis for prediction of obstructive CA, an integer score of 2 to each 0.5 increment in odds ratio was given, and values were divided into quartiles according to the total score. The scores were as follows: age >70 years (6 points), non-STE myocardial infarction (9 points), diabetes mellitus (5 points), B-type natriuretic peptide >90 pg/mL (7 points), neutrophil to lymphocyte ratio >2 (5 points), and high-density lipoprotein cholesterol <50 mg/dL (5 points). CA spasm-induced ACS occurred in 50.0% in Quartile 1 (total score: 0-13), 20.5% in Quartile 2 (total score: 14-19), 4.9% in Quartile 3 (total score: 20-26), and 2.2% in Quartile 4 (total score: 27-37) (P<0.001), indicating that a total score of <20 was a potential clinical indicator of CA spasm-induced ACS.. CA spasm-induced ACS should be suspected if a total score of <20, and a spasm provocation test was being considered.

Topics: Acute Coronary Syndrome; Aged; Cholesterol; Coronary Occlusion; Coronary Vasospasm; Coronary Vessels; Humans; Lipoproteins, HDL; Natriuretic Peptide, Brain; Risk Factors; Spasm

Clinical concern for acute coronary syndrome (ACS) is one of emergency medicine's most common patient encounters. This study aims to develop an ensemble learning-driven framework as a diagnostic support tool to prevent misdiagnosis.. We obtained extensive clinical electronic health data on patient encounters with clinical concerns for ACS from a large urban emergency department (ED) between January 2017 and August 2020. We applied an analytical framework equipped with many well-developed algorithms to improve the data quality by addressing missing values, dimensionality reduction, and data imbalance. We trained ensemble learning algorithms to classify patients with ACS or non-ACS etiologies of their symptoms. We used performance evaluation metrics such as accuracy, sensitivity, precision, F1-score, and the area under the receiver operating characteristic (AUROC) to measure the model's performance.. The analysis included 31,228 patients, of whom 563 (1.8%) had ACS and 30,665 (98.2%) had alternative diagnoses. Eleven features, including systolic blood pressure, brain natriuretic peptide, chronic heart disease, coronary artery disease, creatinine, glucose, heart attack, heart rate, nephrotic syndrome, red cell distribution width, and troponin level, are reported as significantly contributing risk factors. The proposed framework successfully classifies these cohorts with sensitivity and AUROC as high as 86.3% and 93.3%. Our proposed model's accuracy, precision, specificity, Matthew's correlation coefficient, and F1-score were 85.7%, 86.3%, 93%, 80%, and 86.3%, respectively.. Our proposed framework can identify early patients with ACS through further refinement and validation.

Topics: Acute Coronary Syndrome; Creatinine; Emergency Medical Services; Emergency Service, Hospital; Glucose; Humans; Machine Learning; Natriuretic Peptide, Brain; Risk Assessment; Troponin

To explore the level of serum interleukin-37 in patients with acute coronary syndrome (ACS) and its prognostic value.. Altogether, 121 continuous ACS cases from September 2017 to June 2020 were selected as the research group (RG), and 107 healthy individuals during the same period were obtained as the control group (CG). ELISA was applied to test IL-37 in the serum of the CG and the RG. Chemiluminescence immunoassay was applied to test NT-pro BNP and hs-cTnI in each group and immune scattering turbidimetry to test hs-CRP. The correlation of IL-37 with serum NT-pro BNP, hs-cTnI, and CRP was analyzed, and the value of IL-37 in diagnosis and prognosis prediction of patients with ACS was tested. Logistic regression was applied to test the independent risk factors affecting poor prognosis of patients with ACS.. IL-37 was poorly expressed in patients with ACS, which had a high diagnostic value for ACS (sensitivity: 94.39%, specificity: 74.38%, and area under curve: 0.945). There was a negative correlation of IL-37 with serum NT-pro BNP, hs-cTnI, and CRP. IL-37 in patients with poor prognosis was markedly declined compared with that of patients with good prognosis, and the predicted AUC was 0.965. Logistic regression revealed that low IL-37, diabetes, high CRP, NT-pro BNP, and hs-cTnI in the blood were independent risk factors for poor prognosis in patients with ACS.. IL-37 is low expressed in patients with ACS, which has a good diagnostic and prognostic value for ACS, and may be applied as an important marker for the prediction of patients with ACS.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; C-Reactive Protein; Case-Control Studies; Computational Biology; Enzyme-Linked Immunosorbent Assay; Female; Humans; Interleukin-1; Luminescent Measurements; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Risk Factors; Troponin I

Acute coronary syndrome (ACS) is a critical illness in cardiovascular disease. The purpose of this study was to investigate the value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and D-dimer in predicting the occurrence of no reflow in emergency percutaneous coronary intervention (PCI) in patients with ACS. One hundred and sixty-eight ACS patients were recruited, including 88 patients with normal reflow and 80 patients with no reflow after emergency PCI. The levels of serum NT-proBNP and D-dimer in the patients were detected before PCI, immediately after PCI, 2 hours, and 6 months after PCI. The ROC curve was used to evaluate the predictive value of NT-proBNP and D-dimer in no-reflow phenomenon. Logistic regression model was used to analyze the independent influencing factors of no reflow phenomenon. Logistic regression analysis confirmed that NT-proBNP and D-dimer were independent predictors of the occurrence of no reflow in the total population. The ROC curve showed that the AUC value was 0.909 when NT-proBNP combined with D-dimer. The detection of NT-proBNP combined with D-dimer was helpful to predict the occurrence of no-reflow phenomenon after emergency PCI in ACS patients.

Topics: Acute Coronary Syndrome; Female; Fibrin Fibrinogen Degradation Products; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; No-Reflow Phenomenon; Peptide Fragments; Percutaneous Coronary Intervention

Topics: Acute Coronary Syndrome; Biomarkers; C-Reactive Protein; Cysteine; Humans; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Registries; Risk Assessment; Risk Factors; Troponin T

Several studies have recently addressed the importance of glycemic variability (GV) in patients with acute coronary syndrome (ACS). Although daily GV measures, such as mean amplitude of glycemic excursions, are established predictors of poor prognosis in patients with ACS, the clinical significance of day-to-day GV remains to be fully elucidated. We therefore monitored day-to-day GV in patients with ACS to examine its significance.. In 25 patients with ACS, glucose levels were monitored for 14 days using a flash continuous glucose monitoring system. Mean of daily differences (MODD) was calculated as a marker of day-to-day GV. N-terminal pro-brain natriuretic peptide (NT-proBNP) was evaluated within 4 days after hospitalization. Cardiac function (left ventricular end-diastolic volume, left ventricular ejection fraction, stroke volume) was assessed by echocardiography at 3-5 days after admission and at 10-12 months after the disease onset.. Of the 25 patients, 8 (32%) were diagnosed with diabetes, and continuous glucose monitoring (CGM)-based MODD was high (16.6 to 42.3) in 17 patients (68%). Although MODD did not correlate with max creatine kinase (CK), there was a positive correlation between J-index, high blood glucose index, and NT-proBNP (r = 0.83, p < 0.001; r = 0.85, p < 0.001; r = 0.41, p = 0.042, respectively).. In patients with ACS, MODD was associated with elevated NT-proBNP. Future studies should investigate whether day-to-day GV in ACS patients can predict adverse clinical events such as heart failure.

Topics: Acute Coronary Syndrome; Aged; Aged, 80 and over; Biomarkers; Blood Glucose; Blood Glucose Self-Monitoring; Echocardiography; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Patient Admission; Peptide Fragments; Predictive Value of Tests; Prognosis; Stroke Volume; Time Factors; Ventricular Function, Left

To examine the morphological and hemodynamic changes of the ophthalmic artery (OA) in patients with acute coronary syndrome (ACS).. This cross-sectional observational study included 31 patients with ACS and 10 healthy controls (HCs). The ACS subgroups were ST-segment elevation myocardial infarction (STEMI; n = 10), non-STEMI (n = 10), and unstable angina (n = 11). OA three-dimensional (3D) models were reconstructed based on computed tomographic angiography, and morphological aspects of the OA were measured quantitatively. Moreover, numerical simulation by computational fluid dynamics was used to obtain hemodynamic information of the OA.. The study reconstructed 41 OA models. Hemodynamic simulation revealed a significant decrease in OA blood velocity in patients with ACS compared with the HCs (median velocity, 0.046 vs. 0.147 m/s; P < 0.001). No differences in the morphological data for the OA were observed. Also, no differences in the mass flow ratio of OA to the ipsilateral internal carotid artery was found. Similar differences were observed between the ACS subgroups and HCs. OA blood velocity was negatively correlated with body mass index, abdominal circumference, left ventricular ejection fraction, and triacylglycerol and was positively correlated with early to late transmitral flow velocity, N-terminal pro-brain natriuretic peptide, serum creatinine, and potassium.. The initial OA blood velocity was slower in patients with ACS and was associated with ACS-related clinical parameters. To our knowledge, this is the first study to analyze OA characteristics in ACS using 3D model reconstruction and hemodynamic simulation, providing new perspectives on the relationship between ischemic heart disease and ocular manifestations.

Topics: Acute Coronary Syndrome; Aged; Blood Flow Velocity; Carotid Artery, Internal; Computed Tomography Angiography; Creatinine; Cross-Sectional Studies; Female; Hemodynamics; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Male; Middle Aged; Natriuretic Peptide, Brain; Ophthalmic Artery; Peptide Fragments; Potassium; Regional Blood Flow; Stroke Volume; Triglycerides; Ventricular Function, Left

Aim    To evaluate clinical features of the course of acute coronary syndrome (ACS) in patients with oncological diseases (OD) and to determine the role of biomarkers GDF-15, NT-proBNP, and hs-CRP in short-term and long-term prognoses.Material and methods    In 88 patients (34 patients with ACS and OD and 54 patients with ACS without OD), complaints and historical, objective, and laboratory and instrumental data were evaluated and blood concentrations of GDF-15, NT-proBNP, and hs-CRP biomarkers were measured on the first day of hospitalization. Incidence of cardiovascular complications (CVC) and outcomes of hospital and long-term (6 months) periods were analyzed. Statistical analysis of results was performed with the Statistica 12.0, MedCalc 19.1.7 software. The level of statistical significance was р<0.05.Results    In the ACS+OD group as compared to the ACS without OD group, the onset of disease was mostly atypical, with shortness of breath and/or general weakness; the ACS+OD patients more frequently had III-IV Killip class acute heart failure (29 and 7 %, р=0.01); mean hemoglobin concentration (125.6±27.9 and 141±16.6 g/l, р=0.003), prothrombin index (76.4±15.2 and 84.9±17.6 %, р=0.003), and left ventricular ejection fraction (47.7±6.1 and 50.7±7.2 %, р=0.02) were lower; and median concentrations of GDF-15 (1.95 [1.3; 2.8] and 1.45 [1.2; 2.0] ng/ml, р=0.03), NT-proBNP (947.3 [517.8; 1598.2], and 491.1 [85.1; 1069.1] pg/ml, р=0.006), and hs-CRP (14.1 [8.15; 36.75] and 7.8 [4.4; 16.2] mg/l, р=0.01) were higher. The presence of OD was associated with development of CVC, including urgent endpoints in the long-term and also increased the probability of fatal outcome within 6 months after discharge from the hospital. To predict the risk of CVC in patients with ACS and OD, two models with high prognostic values (AUC>0.9) were proposed. In the long-term, the value of NT-proBNP (cut-off point >524.5 pg/ml) was a statistically significant predictor for development of endpoints with a high predictive value (AUC>0.8).Conclusion    The features of the clinical course of ACS in patients with OD indicate the importance of isolating such patients into a separate group. Additional use of the developed models, along with a standard risk assessment by the GRACE scale, will allow individualized management of patients with ACS and OD during the hospital and long-term (6 months) periods.

Topics: Acute Coronary Syndrome; Biomarkers; C-Reactive Protein; Growth Differentiation Factor 15; Hospitals; Humans; Natriuretic Peptide, Brain; Neoplasms; Peptide Fragments; Prognosis; Stroke Volume; Ventricular Function, Left

 In the present study, we aimed to establish a novel score to predict long-term mortality of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients who underwent percutaneous coronary intervention (PCI)..  A total of 2,174 NSTE-ACS patients from the CORFCHD-ZZ study were enrolled as the derivation cohort. The validation cohort including 1,808 NSTE-ACS patients were from the CORFCHD-PCI study. Receiver operating characteristic analysis and area under the curve (AUC) evaluation were used to select the candidate variables. The model performance was validated internally and externally. The primary outcome was cardiac mortality (CM). We also explored the model performance for all-cause mortality (ACM)..  Initially, 28 risk factors were selected and ranked according to their AUC values. Finally, we selected age, N-terminal pro-B-type natriuretic peptide, and creatinine to develop a novel prediction model named "ABC" model. The ABC model had a high discriminatory ability for both CM (C-index: 0.774,.  In the present study, we developed and validated a novel model to predict mortality in patients with NSTE-ACS who underwent PCI. This model can be used as a credible tool for risk assessment and management of NSTE-ACS after PCI.

Topics: Acute Coronary Syndrome; Aged; Creatinine; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Percutaneous Coronary Intervention; Prognosis; Risk Assessment; Risk Factors

Perioperative myocardial injury after noncardiac surgery affects more than 10% of individuals, with increased morbidity and mortality. Perioperative cardiac risk assessment targets the identification of this high-risk population using preoperative natriuretic peptides and postoperative troponin measurements. Our objective was to assess the use of these biomarkers in the province of Alberta.. A retrospective cohort of all patients who underwent noncardiac surgery in Alberta from January 2013 to December 2017 was created using linked provincial administrative databases. Inclusion criteria were modified from recommendations for perioperative cardiac screening including: patients with a Revised Cardiac Risk Index score ≥ 1 and age 65 years or older, or 45 years of age or older with history of cardiovascular disease, with planned overnight hospital stay.. In our cohort of 59,506 patients, only 6.8% underwent preoperative natriuretic peptide screening. Rates of appropriate preoperative natriuretic peptide testing increased marginally from 5.7% to 8.8% over the study period. Postoperative troponin was measured at least once in 19.5% of patients. Patients with elevated perioperative screening biomarkers showed increased 6-month mortality, and increased hospitalizations for heart failure and acute coronary syndromes.. The use of biomarkers to assist in cardiac risk stratification and postoperative monitoring remains low. Addressing access to these tests and improving physician education regarding the asymptomatic nature of postoperative cardiac events might improve compliance with national guidelines.

Topics: Acute Coronary Syndrome; Aged; Alberta; Biomarkers; Cohort Studies; Female; Heart Failure; Hospitalization; Humans; Male; Mass Screening; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Postoperative Care; Postoperative Complications; Preoperative Care; Retrospective Studies; Risk Assessment; Troponin

Endogenous testosterone levels decrease in men with aging. Controversies persist regarding the screening and treatment of low testosterone levels in patients with acute coronary syndromes (ACS).. Total serum testosterone levels were measured in 1054 men hospitalized for ACS that were part of a Swiss prospective cohort. Total testosterone levels were classified first in tertiles and using the cut-off of 300 ng/dL. Primary endpoint was all-cause mortality at one year. Cox regression models adjusting for the GRACE score (composite of age, heart rate systolic blood pressure, creatinine, cardiac arrest at admission, ST segment deviation, abnormal troponin enzyme and Killip classification), preexisting diabetes and inflammation (high-sensitivity C-reactive protein). A total of 430 men (40.8%) had total testosterone levels ≤300 ng/dL. Low total testosterone levels were correlated with lower high-density lipoprotein cholesterol and higher triglycerides, high-sensitivity C-reactive protein, high-sensitivity troponin T, N-terminal-pro B-type natriuretic peptide and glucose levels (all p < 0.01). Patients in the lowest testosterone tertile had a mortality rate at one-year of 5.4% compared with 2.9% in the highest tertile with an unadjusted hazard ratio of 1.92 (95% confidence interval 0.96-1.90, p = 0.095) and adjusted hazard ratio of 1.26 (95% confidence interval 0.57-2.78, p = 0.565). In an exploratory analysis, the highest mortality rate (10.3%) was observed in men aged >65 years old belonging to the lowest testosterone tertile.. In this large population of men with ACS, we found a prevalence of low total endogenous testosterone levels of almost 40%. However, low testosterone levels were not significantly associated with mortality after adjustment for high-risk confounders.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Humans; Male; Natriuretic Peptide, Brain; Prognosis; Prospective Studies; Risk Factors; Testosterone

Diagnosis and grading of diastolic dysfunction (DD) is challenging, with different studies using heterogeneous criteria and guidelines not routinely applied in clinical practice. Our aim was to apply the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging classification of DD among a contemporary population of patients with acute coronary syndromes (ACS) by analyzing its correlation with N-terminal pro b-type natriuretic peptide (NT-proBNP) and impact on clinical outcomes.. Independent investigators blinded to each other and to the clinical history reviewed digitally stored images to apply 2016 and 2009 DD definitions to 380 patients (mean age 66 ± 13 years, 75% men) with ACS admitted to the coronary care unit between January 2016 and March 2018.. DD was frequent with both definitions, yet the concordance was weak (kappa =0.21, p < 0.01). Inter-observer reliability was greater by applying the 2016 algorithm (kappa = 0.89, p < 0.001). There was a significant correlation between NT-proBNP and worsening DD (Spearman's rho r = 0.54 for 2016 and r = 0.24 for 2009 algorithms, both p < 0.001). Worse DD was associated with worse clinical presentation and increased risk of events (HR for the cumulative incidence of heart failure and death during follow-up 2.15 [95% CI 1.66-2.78, p < 0.001] and 1.82 [95% CI 1.39-2.40, p < 0.001] for 2016 and 2009 classifications, respectively, all p < 0.001).. The agreement between 2016 and 2009 DD definitions was poor, with newer guidelines having grater interobserver reliability. The positive graded association between 2016 DD classification and NT-proBNP and its association with clinical outcomes provide a validation of the latest guideline algorithm in ACS patients.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Echocardiography; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Reproducibility of Results; United States

Plasma levels of brain natriuretic peptides have better diagnostic accuracy compared to clinical-radiologic judgment for acute heart failure. In acute coronary syndromes (ACS), the prognostic value of acute heart failure is incorporated into predictive models through Killip classification. It is not established whether NT-proBNP could increment prognostic prediction.. To evaluate whether NT-proBNP, as a measure of left ventricular dysfunction, improves the in-hospital prognostic value of the GRACE score in ACS.. Patients admitted due to acute chest pain, with electrocardiogram and/or troponin criteria for ACS were included in the study. The plasma level of NT-proBNP was measured at hospital admission and the primary endpoint was defined as cardiovascular death during hospitalization. P-value < 0.05 was considered as significant.. Among 352 patients studied, cardiovascular mortality was 4.8%. The predictive value of NT-proBNP for cardiovascular death was shown by a C-statistic of 0.78 (95% CI = 0.65-0.90). After adjustment for the GRACE model subtracted by Killip variable, NT-proBNP remained independently associated with cardiovascular death (p = 0.015). However, discrimination by the GRACE-BNP logistic model (C-statistics = 0.83; 95%CI = 0.69-0.97) was not superior to the traditional GRACE Score with Killip (C-statistic = 0.82; 95%CI = 0.68-0.97). The GRACE-BNP model did not provide improvement in the classification of patients to high risk by the GRACE Score (net reclassification index = - 0.15; p = 0.14).. Despite the statistical association with cardiovascular death, there was no evidence that NT-proBNP increments the prognostic value of GRACE score in ACS.

Topics: Acute Coronary Syndrome; Biomarkers; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Risk Assessment

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies; Renal Insufficiency, Chronic; Risk Factors; Romania; ST Elevation Myocardial Infarction

To study the relationship of red cell distribution width (RDW) and N-terminal pro-brain natriuretic peptide (NT-proBNP) with the severity and prognosis of patients with acute coronary syndrome (ACS) receiving percutaneous coronary intervention (PCI).. A total of 396 patients were divided into four groups according to Gensini scores. They were divided into a major adverse cardiovascular event (MACE) group and a non-MACE group during follow-up. The baseline clinical data, blood biochemical indices, RDW, and NT-proBNP levels on the second day of admission were collected. The relationship of RDW and NT-proBNP with MACEs was analyzed by the Cox proportional hazard model, and risk stratification was conducted according to optimal cutoff values under ROC curves.. RDW and NT-proBNP level were significantly positively correlated with Gensini score (p < 0.05). RDW and NT-proBNP level of the MACE group significantly exceeded those of the non-MACE group (p < 0.05). The AUC values of RDW and NT-proBNP level were 0.722 and 0.761, respectively. The optimal cutoff values were 31.86 and 1,486.65 pg/mL respectively. RDW of > 31.86 and NT-proBNP level of > 1,487.65 pg/mL were independent risk factors for MACEs in ACS patients. The patients were stratified according to the optimal cut-off values. Compared with the low-risk group, the MACE risks of middle-risk and high-risk groups increased 1.79-fold (p = 0.012) and 2.54-fold (p < 0.001), respectively. The patients had significantly different event-free survival rates (p < 0.001).. RDW and NT-proBNP level were significantly correlated with the severity of ACS. They were independent predictors for MACEs in ACS patients.

Topics: Acute Coronary Syndrome; Adult; Aged; Aged, 80 and over; Biomarkers; Erythrocyte Indices; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Percutaneous Coronary Intervention; Prognosis; Risk Assessment; Risk Factors; ROC Curve; Severity of Illness Index

To investigate the correlation between uric acid (UA) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and coronary artery severity in acute coronary syndrome patients of different sexes.A total of 134 patients with acute coronary syndrome (ACS) were investigated. According to sex, there were 96 cases in male group and 38 cases in female group. According to the number of diseased vessels, the degree of coronary artery lesion was determined and divided into negative group (n = 21), single vessel lesion group (n = 43), double vessel lesion group (n = 38), and 3 vessel lesion group (n = 32).Univariate analysis showed that UA, NT-proBNP was correlated with the severity of ACS (P < .05). UA was an independent risk factor for the severity of coronary artery disease in female group (P < .05), but not in male group (P > .05). There was no significant correlation between NT-proBNP and severity of coronary artery disease in different sex (P > .05).UA was significantly correlated with the severity of coronary heart disease, especially in women, but not in men. The level of NT-proBNP was positively correlated with the severity of coronary artery, but no significant difference was found in different sexes.

Topics: Acute Coronary Syndrome; Aged; Aged, 80 and over; Biomarkers; Coronary Angiography; Coronary Artery Disease; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Retrospective Studies; Risk Factors; Severity of Illness Index; Sex Characteristics; Uric Acid

This study aims to estimate prognostic indicators of new onset atrial fibrillation (AF) in patients with acute coronary syndrome (ACS) through 3 to 5 years of follow-up.. For patients with ACS, some prognostic indicators can be used to predict new onset AF.. The Improving Care for Cardiovascular Disease in China-ACS (CCC-ACS) program was launched in 2014 by a collaborative initiative of the American Heart Association and Chinese Society of Cardiology. We enrolled 866 patients with ACS in a telephone follow-up program. We inquired about each patient's general health and invited each patient to our hospital for further consultation. We also performed ambulatory electrocardiography and other relevant examinations.. A total of 743 ACS patients were included in the study. After 3 to 5 years, 50 (0.67%) patients developed AF. In multivariable Cox models adjusting for AF risk factors in ACS patients, we found that NT-proBNP [hazard ratio (HR) 2.625, 1.654-4.166, P < .05], creatine kinase-MB (CK-MB) (HR 4.279, 1.887-9.703, P < .05), and left ventricular ejection fraction (LVEF) (HR 0.01, 0.001-0.352, P < .05) were significantly associated with AF receiver operating characteristic (ROC) curves were used to determine a cutoff level for AF screening. NT-proBNP using a cutoff of 1705 ng/L resulted in a sensitivity of 58% and a specificity of 89.8%. CK-MB using a cutoff of 142.5 ng/L resulted in a sensitivity of 73.3% and a specificity of 58.3%.. For patients with ACS, NT-proBNP, CK-MB, and LVEF have a considerable prognostic value for predicting whether AF would be detected during follow-up.

Topics: Acute Coronary Syndrome; Atrial Fibrillation; Biomarkers; Creatine Kinase, MB Form; Electrocardiography, Ambulatory; Female; Follow-Up Studies; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Protein Precursors; Retrospective Studies; Risk Factors; ROC Curve; Time Factors; Ventricular Function, Left

Risk stratification with specific biomarkers is proposed for tailored P2Y12 inhibitor therapy in patients with STEMI.. This nationwide registry and quality improvement study is from November 1, 2014, to June 30, 2017. In total, 11,512 STEMI patients received aspirin and P2Y12 receptor inhibitor (clopidogrel or ticagrelor) and underwent PCIs in hospitals. Of the patients, 2992 were prescribed ticagrelor and 8520 clopidogrel. The primary effectiveness outcome was major adverse cardiovascular and cerebrovascular events (MACCE: cardiac death, myocardial infarction, stent thrombosis, in-hospital ischemic stroke). The primary safety outcome was in-hospital major bleeding.. MACCE incidence was lower in the ticagrelor group than in the clopidogrel group (0.8% versus 1.2%; P=0.046), but under different NT-proBNP levels, cumulative hazards of MACCE were without statistical significance. Bleeding rates were higher in the ticagrelor group than in the clopidogrel group (all bleeding: 9.9% versus 6.9%, P<0.001; major bleeding: 4.0% versus 2.7%, P<0.001). The higher cumulative hazard of bleeding could be identified in the Kaplan-Meier curves. In the multivariate analysis, ticagrelor increased bleeding events, compared with clopidogrel, at NT-proBNP >1800 ng/L patients (all bleeding: HR 1.46; 95%CI, 1.07-2.01; major bleeding: HR 1.68, 95%CI, 1.03-2.74), but a low effect was found in those with lower NT-proBNP level. Subgroup analyses show that ticagrelor increased major bleeding in patients with left ventricular ejection fraction (LVEF) <0.50 (HR 3.29; 95% CI 1.61-6.74) (interaction p=0.03).. We found that ticagrelor, compared with clopidogrel, increased bleeding complications in hospitalized patients with NT-proBNP>1800 ng/L, especially in patients with EF < 0.50.

Topics: Acute Coronary Syndrome; Clopidogrel; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors; ST Elevation Myocardial Infarction; Stroke Volume; Ticagrelor; Treatment Outcome; Ventricular Function, Left

Objective To study the prognostic role of current serum biomarkers in patients with myocardial infarction (MI) by constructing a multifactorial model for prediction of cardiovascular complications (CVC) in remote MI. Acute coronary syndrome is a major cause of death and disability in the Russian Federation. Introduction of current biomarkers, such as N-terminal pro-brain natriuretic peptide, stimulating growth factor (ST2), and centraxin-2 (Pentraxin, Ptx-3), provides more possibilities for diagnostics and calculation of risk for CVC.Materials and Methods Concentrations of biomarkers were measured in 180 patients with MI (mean age, 61.4±1.7) upon admission. At one year, specific and composite endpoints were determined (MI, acute cerebrovascular disease, admission for CVD, and cardiovascular death). Based on this information, a prognostic model for subsequent events was developed.Results A mathematical model was created for computing the development of a composite endpoint. In this model, the biomarkers NT-proBNP, Ptx-3 and, to a lesser extent, ST2 demonstrated their prognostic significance in diagnosis of CVC with a sensitivity of 78.79 % and specificity of 86.67 % (area under the curve, AUC 0.73).Conclusion In patients with remote MI, the biomarkers NT-proBNP, ST2, and Ptx-3 improve prediction of CVC.

Topics: Acute Coronary Syndrome; Biomarkers; Humans; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Russia

Objectives Details of the biological variability of high-sensitivity C-reactive protein (hs-CRP), N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and ST2 are currently lacking in patients with acute coronary syndrome (ACS) but are crucial knowledge when aiming to use these biomarkers for personalized risk prediction. In the current study, we report post-ACS kinetics and the variability of the hs-CRP, NT-proBNP and ST2. Methods BIOMArCS is a prospective, observational study with high frequency blood sampling during 1 year post-ACS. Using 1507 blood samples from 191 patients that remained free from adverse cardiac events, we investigated post-ACS kinetics of hs-CRP, NT-proBNP and ST2. Biological variability was studied using the samples collected between 6 and 12 months after the index ACS, when patients were considered to have stable coronary artery disease. Results On average, hs-CRP rose peaked at day 2 and rose well above the reference value. ST2 peaked immediately after the ACS but never rose above the reference value. NT-proBNP level rose on average during the first 2 days post-ACS and slowly declined afterwards. The within-subject variation and relative change value (RCV) of ST2 were relatively small (13.8%, RCV 39.7%), while hs-CRP (41.9%, lognormal RCV 206.1/-67.3%) and NT-proBNP (39.0%, lognormal RCV 185.2/-64.9%) showed a considerable variation. Conclusions Variability of hs-CRP and NT-proBNP within asymptomatic and clinically stable post-ACS patients is considerable. In contrast, within-patient variability of ST2 is low. Given the low within-subject variation, ST2 might be the most useful biomarker for personalizing risk prediction in stable post-ACS patients.

Topics: Acute Coronary Syndrome; Adult; Aged; Biomarkers; C-Reactive Protein; Coronary Artery Disease; Female; Humans; Interleukin-1 Receptor-Like 1 Protein; Longitudinal Studies; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies; Risk Assessment; Risk Factors

Topics: Acute Coronary Syndrome; Adult; Aged; Cohort Studies; Emergency Service, Hospital; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Retrospective Studies; Troponin T

Topics: Acute Coronary Syndrome; Biomarkers; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Risk Assessment

There are limited data regarding the association between brain natriuretic peptide (BNP) levels obtained after weaning from extracorporeal membrane oxygenation (ECMO) and the outcomes of patients with acute coronary syndrome (ACS)-associated cardiogenic shock.We prospectively obtained data regarding patients (aged ≥ 19 years) with ACS-associated cardiogenic shock who received ECMO and were subsequently weaned off the treatment. BNP levels were collected at 5 time points: pre-ECMO implantation, post-ECMO implantation, pre-ECMO weaning, day 1 after ECMO weaning, and day 5 after ECMO weaning.Of 48 patients with ACS-related cardiogenic shock, 33 were included in this analysis. Mean patient age was 59.0 (50.0-66.5) years, and 5 patients (15.2%) were women. Eight patients had asystole/pulseless electrical activity before ECMO and 14 (42.4%) had 3-vessel disease on coronary angiography. During the 6-month follow up, 12 (36.4%) patients died. BNP levels after ECMO weaning were significantly different between 6-month survivors and non-survivors. Cox proportional hazards model revealed that BNP levels (tertiles) on days 1 and 5 after ECMO weaning were significantly associated with 6-month mortality (hazard ratio, 7.872; 95% confidence interval, 1.870-32.756; 8.658 and 1.904-39.365, respectively). According to the Kaplan-Meier curves, the first tertile had significantly longer survival compared to the third tertile for both days 1 and 5 after ECMO weaning.Post-ECMO weaning BNP levels (days 1 and 5) were significantly associated with increased 6-month mortality in patients with ACS complicated by refractory cardiogenic shock who were weaned off ECMO.

Topics: Acute Coronary Syndrome; Extracorporeal Membrane Oxygenation; Female; Humans; Kaplan-Meier Estimate; Middle Aged; Natriuretic Peptide, Brain; Proportional Hazards Models; Risk Factors; Shock, Cardiogenic

Topics: Acute Coronary Syndrome; Female; Humans; Hyperuricemia; Male; Mortality; Natriuretic Peptide, Brain; Sex Characteristics

To investigate the association between plasma S100A1 level and ST-segment elevation myocardial infarction (STEMI) and potential significance of S100A1 in post-infarction cardiac function.. We examined the plasma S100A1 level in 207 STEMI patients (STEMI group) and 217 clinically healthy subjects for routine physical examination without a history of coronary artery disease (Control group). Baseline characteristics and concentrations of relevant biomarkers were compared. The relationship between S100A1 and other plasma biomarkers was detected using correlation analysis. The predictive role of S100A1 on occurrence of STEMI was then assessed using multivariate ordinal regression model analysis after adjusting for other covariates.. The plasma S100A1 level was found to be significantly higher (P<0.001) in STEMI group (3197.7±1576.0 pg/mL) than in Control (1423.5±1315.5 pg/mL) group. Furthermore, the correlation analysis demonstrated plasma S100A1 level was significantly associated correlated with hypersensitive cardiac troponin T (hs-cTnT) (r = 0.32; P < 0.001), creatine kinase MB (CK-MB) (r = 0.42, P < 0.001), left ventricular eject fraction (LVEF) (r = -0.12, P = 0.01), N-terminal prohormone of brain natriuretic peptide (NT-proBNP) (r = 0.61; P < 0.001) and hypersensitive C reactive protein (hs-CRP) (r = 0.38; P < 0.001). Moreover, the enrolled subjects who with a S100A1 concentration ≤ 1965.9 pg/mL presented significantly better cardiac function than the rest population. Multivariate Logistic regression analysis revealed that S100A1 was an independent predictor for STEMI patients (OR: 0.671, 95% CI 0.500-0.891, P<0.001). In addition, higher S100A1 concentration (> 1965.9 pg/mL) significantly increased the risk of STEMI as compared with the lower level (OR: 6.925; 95% CI: 4.15-11.375; P<0.001).. These results indicated that the elevated plasma S100A1 level is an important predictor of STEMI in combination with several biomarkers and also potentially reflects the cardiac function following the acute coronary ischemia.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; C-Reactive Protein; Case-Control Studies; Creatine Kinase, MB Form; Echocardiography, Doppler; Female; Heart Function Tests; Humans; Logistic Models; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Retrospective Studies; S100 Proteins; ST Elevation Myocardial Infarction; Troponin T

Influence of pre-existing treatment with aspirin and/or statins prior to a first acute coronary syndrome (ACS) on clinical presentation, infarct size and inflammation markers. We analyzed patients from the Swiss Program University Medicine ACS-cohort (SPUM-ACS; ClinicalTrials.govnumber:NCT01075867).. 1639 patients were categorized into 4 groups: (1) patients without either drug (n = 1181); (2) patients only on aspirin (n = 157); (3) patients only on statins (n = 133) and (4) patients on both drugs (n = 168). Clinical features, electrocardiogram (ECG), creatinine kinase (CK, U/l), high-sensitivity troponin T (hsTNT, μg/l), N-terminal brain natriuretic peptide (NT-proBNP, ng/l), leucocytes (Lc, G/l), neutrophils (Nc, G/l), C-reactive protein (CRP, mg/l) and angiographic features were documented at baseline.. Incidences of ST-elevation myocardial infarction (STEMI) were 64% in group 1, 45% in group 2, 52% in group 3 and 40% in group 4 (p < 0.0001). Those with both drugs had significantly lower CK (median 145 U/l, interquartile range (IQR) 89-297), hsTNT (median 0.13 μg/l, IQR 0.03-0.52) and higher left ventricular ejection fraction values (LVEF) (mean 55 ± 12%) compared to untreated patients (median CK 273 U/l, IQR 128-638; median hsTNT 0.26 μg/l, IQR 0.08-0.85; mean LVEF 51 ± 11%) (p < 0.0001, p = 0.001, p = 0.028, respectively). Co-medicated groups matched for high risk factors presented less frequently as STEMIs (p < 0.0001), had significantly smaller infarcts determined by CK and hsTNT (both p < 0.0001) and lower CRP levels (p = 0.01) compared to patients without pre-existing treatment with either drug.. Pre-existing treatment with aspirin and/or statins and particularly with their combination changes the clinical presentation, infarct size, inflammation markers and LVEF in patients suffering their first ACS.

Topics: Acute Coronary Syndrome; Aged; Aspirin; Biomarkers; C-Reactive Protein; Coronary Angiography; Electrocardiography; Female; Follow-Up Studies; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Inflammation; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Platelet Aggregation Inhibitors; Prognosis; Prospective Studies; Stroke Volume; Troponin T; Ventricular Function, Left

Topics: Acute Coronary Syndrome; Biomarkers; C-Reactive Protein; Case-Control Studies; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Netherlands; Peptide Fragments; Predictive Value of Tests; Prognosis; Risk Factors; Time Factors; Troponin; Up-Regulation

Background Small studies have suggested an association between markers of collagen turnover and adverse outcomes in heart failure ( HF ). We examined C-terminal telopeptide (beta- CT x) and the risk of cardiovascular death or new or worsening HF in non- ST -elevation acute coronary syndrome. Methods and Results We measured baseline serum beta- CT x, NT -pro BNP (N-terminal pro-B-type natriuretic peptide), hsTnT (high-sensitivity cardiac troponin T) and hs CRP (high-sensitivity C-reactive protein) (Roche Diagnostics) in a nested biomarker analysis (n=4094) from a study of patients with non- ST -elevation acute coronary syndrome. The relationship between quartiles of beta- CT x and cardiovascular death or HF over a median follow-up time of 12 months was analyzed using adjusted Cox models. Higher beta- CT x levels identified a significantly higher risk of cardiovascular death/ HF (Q4 10.9% versus Q1 3.8%, Logrank P<0.001). After multivariable adjustment, beta- CT x in the top quartile (Q4) was associated with cardiovascular death/ HF (Q4 versus Q1: adjusted hazard ratio 2.22 [1.50-3.27]) and its components (Q4 versus Q1: cardiovascular death: adjusted hazard ratio 2.48 [1.46-4.21]; HF : adjusted hazard ratio 2.04 [1.26-3.30]). In an adjusted multimarker model including NT -pro BNP , hsTnT, and hs CRP , beta- CT x remained independently associated with cardiovascular death/ HF (Q4 versus Q1: adjusted hazard ratio 1.98 [1.34-2.93]) and its components. Beta- CT x correlated weakly with NT -pro BNP ( r=0.17, P<0.001) and left ventricular ejection fraction ( r=-0.05, P=0.008) and did not correlate with hsTnT ( r=0.02, P=0.20), or hs CRP ( r=-0.03, P=0.09). Conclusions Levels of beta- CT x, a biomarker of collagen turnover, were associated with cardiovascular death and HF in patients with non- ST -elevation acute coronary syndrome. This biomarker, which correlated only weakly or not significantly with traditional biomarkers of cardiovascular death and HF , may provide complementary pathobiological insight and risk stratification in these patients.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; C-Reactive Protein; Collagen Type I; Disease Progression; Female; Heart Failure; Humans; Incidence; Male; Middle Aged; Natriuretic Peptide, Brain; Non-ST Elevated Myocardial Infarction; Peptide Fragments; Peptides; Predictive Value of Tests; Prognosis; Randomized Controlled Trials as Topic; Risk Assessment; Risk Factors; Time Factors; Troponin T

Glucose is an important preferential substrate for energy metabolism during acute coronary syndrome (ACS) attack, although insulin resistance (IR) increases during ACS. Increasing evidence indicates that natriuretic peptides (NP) regulate glucose homeostasis. We investigated possible compensatory actions of NP in collaboration with other neurohumoral factors that facilitate glucose utilization during ACS. The study population consisted of 1072 consecutive cases with ischemic heart disease who underwent cardiac catheterization (ACS, n = 216; non-ACS, n = 856). Among ACS subjects, biochemical data after acute-phase treatment were available in 91 cases, defined as ACS-remission phase (ACS-rem). Path models based on covariance structure analyses were proposed to clarify the direct contribution of B-type NP (BNP) and noradrenaline to glucose and HOMA-IR levels while eliminating confounding biases. In non-ACS and ACS-rem subjects, although noradrenaline slightly increased glucose and/or HOMA-IR levels (P < 0.03), BNP did not significantly affect them. In contrast, in ACS subjects, high noradrenaline was a significant cause of increases in glucose and HOMA-IR levels (P < 0.001), whereas high BNP was a significant cause of decreases in both parameters (P < 0.005). These findings indicate that BNP and noradrenaline coordinately activate glucose metabolism during ACS, with noradrenaline increasing glucose levels, as an energy substrate, while BNP improves IR and promotes glucose utilization.

Topics: Acute Coronary Syndrome; Aged; Angiotensin II Type 1 Receptor Blockers; Blood Glucose; Cardiac Catheterization; Female; Humans; Insulin; Insulin Resistance; Male; Middle Aged; Natriuretic Peptide, Brain; Norepinephrine; Retrospective Studies

Iodinated contrast agent (ICA)-induced acute kidney injury (AKI) following acute coronary syndrome (ACS) is a frequent complication, which may lead to chronic kidney disease and increased mortality. Optical coherence tomography angiography (OCT-A) of the retina is new tool delivering a rapid and noninvasive assessment of systemic microvascularization, which is potentially involved in the occurrence of ICA-induced AKI. Between October 2016 and March 2017, 452 ACS patients were admitted to our cardiac intensive care unit. OCT-A was performed within 48 h after the ICA injection. Patients with a history of retinal disease were excluded. The patients included were divided into two groups depending on whether or not AKI occurred after injection of ICA, according to KDIGO criteria. Of the 216 patients included, 21 (10%) presented AKI. AKI was significantly associated with age, Mehran score, GRACE score, and NT-proBNP. AKI patients had significantly lower retinal vascular density (RVD)) and had more frequent low RVD (81% vs 45%, P = 0.002). Adding low RVD to the Mehran score and the NT-proBNP, or to the GRACE score and the NT-proBNP, significantly improved their predictive values, suggesting that systemic microvascular involvement remains incompletely addressed by either standard risk scores or factors known to be associated with ICA-induced AKI.

Topics: Acute Coronary Syndrome; Acute Kidney Injury; Aged; Aged, 80 and over; Biomarkers; Computed Tomography Angiography; Contrast Media; Coronary Angiography; Feasibility Studies; Female; Humans; Intensive Care Units; Kidney; Male; Microvessels; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prospective Studies; Reproducibility of Results; Retinal Vessels; Risk Assessment; Tomography, Optical Coherence

Background Defects in human cognition commonly result in clinical reasoning failures that can lead to diagnostic errors. A metacognitive structured reflection on what clinical findings fit and/or do not fit with likely and "can't miss" diagnoses may reduce such errors. Case presentation A 57-year-old man was sent to the emergency department from clinic with chest pain, severe shortness of breath, weakness, and cold sweats. Further investigation revealed multiple risk factors for coronary artery disease, sudden onset of exertional dyspnea, and chest pain that incompletely resolved with rest, mild tachycardia and hypoxia, an abnormal electrocardiogram (ECG), elevated serum cardiac biomarkers, and elevated B-type natriuretic peptide (BNP) in the absence of left-sided heart failure. He was treated for acute coronary syndrome (ACS), discharged, and quickly returned with worsening symptoms that eventually led to a diagnosis of submassive pulmonary embolism (PE). Conclusions Through integrated commentary on the diagnostic reasoning process from clinical reasoning experts at two institutions, this case underscores the importance of frequent assessment of fit along with explicit explanation of dissonant features in order to avoid premature closure and diagnostic error. A fishbone diagram is provided to visually demonstrate the major factors that contributed to the diagnostic error. A case discussant describes the importance of diagnostic schema as an analytic reasoning strategy to assist in the creation of a differential diagnosis, problem representation to summarize updated findings, a Popperian analytic approach of attempting to falsify less-likely hypotheses, and matching pertinent positives and negatives to previously learned illness scripts. Finally, this case provides clinical teaching points in addition to a pitfall, myth, and pearl specific to premature closure.

Topics: Acute Coronary Syndrome; Chest Pain; Clinical Decision-Making; Cognitive Dissonance; Diagnostic Errors; Dyspnea; Emergency Service, Hospital; Humans; Male; Mental Processes; Middle Aged; Natriuretic Peptide, Brain; Pulmonary Embolism

To know the clinical profile as well as the prognostic significance of elevated levels of parathyroid hormone (PTH) in patients admitted for acute coronary syndrome (ACS).. Observational and prospective study of patients admitted for ACS in a single Spanish center during a period of six months.. The circulating concentrations of PTH, calcidiol, calcitriol, NT-proBNP, C-reactive protein, cystatinC and fibrinogen were determined within the first 48h at admission. We performed adjusted models to predict death or re-entry for ACS after hospital discharge.. A total of 161 patients were recruited (age 67±14 years, 75.2% were men). Forty-one (25.5%) patients had elevated PTH values. During follow-up for a period of 275 person-years, 50 adverse events were recorded. Patients with elevated PTH levels were proportionally more women (21.2 vs. 39.0%) and older (63.3 vs. 77.8 years, both P<.05). Likewise, they presented significantly more cardiovascular risk and a worse prognosis during follow-up (incidence rate ratio 2.64 CI 95%: 1.5-4.6). However, in an adjusted model by the GRACE score, PTH levels were not shown to be an independent risk factor (hazard ratio=1.1; 95% CI: 0.6-2.2), neither other components of the panel.. The proportion of patients with elevated levels of PTH admitted for ACS was high. The presence of high PTH levels was associated with an unfavorable clinical profile and a worse outcome during the follow-up, although it was not an independent predictor of poor prognosis.

Topics: Acute Coronary Syndrome; Aged; Aged, 80 and over; Biomarkers; C-Reactive Protein; Calcifediol; Calcitriol; Cystatin C; Female; Fibrinogen; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Natriuretic Peptide, Brain; Parathyroid Hormone; Peptide Fragments; Prognosis; Proportional Hazards Models; Prospective Studies; Risk Factors

Plasma levels of atherothrombosis-related markers such as endothelial biomarkers have been reported to predict the risk of first acute coronary syndrome (ACS) events. Percutaneous coronary intervention (PCI) by balloon angioplasty and stenting established as a treatment for ACS enabled early discharge and early clinic care. The procedure of PCI, however, may itself be associated with arterial injury with endothelial dysfunction. The clinical significance of those biomarkers for second events in patients after PCI has not yet been completely understood to identify patients who need strict follow-up.. After the exclusion of 100 patients (60 deaths during hospitalization, 40 severe renal failure), 400 ACS patients (291 males, 71.1±13.0 years) who had undergone successful PCI followed by biomarker assessment within the first postoperative hour were enrolled. We evaluated atherothrombosis-related biomarkers: thrombomodulin (TM), C-reactive protein (CRP), and D-dimer, prothrombin fragment F1+2, and plasminogen activator inhibitor-1, other than those assessed by routine biochemical tests. The outcome after PCI in ACS patients was assessed by the incidence of major adverse cardiovascular events (MACEs).. MACEs occurred in 112 patients during the follow-up period (813.9±474.8 days). As in previous reports, patients with MACEs showed decreased left ventricular ejection fraction (LVEF) by echocardiography, elevated brain natriuretic peptide and HbA1c than patients without MACEs. Not only these markers but also TM were significantly associated with MACEs in multivariate analysis. There were no significant correlations between MACEs and CRP. The association between TM and MACEs was especially high (odds ratio 2.73) and unaffected by the stage of cardiac (≤40, 40

Topics: Acute Coronary Syndrome; Aged; Angioplasty, Balloon, Coronary; Biomarkers; C-Reactive Protein; Cardiovascular Diseases; Female; Heart; Humans; Incidence; Male; Middle Aged; Natriuretic Peptide, Brain; Odds Ratio; Peptide Fragments; Percutaneous Coronary Intervention; Plasminogen Activator Inhibitor 1; Postoperative Complications; Postoperative Period; Prothrombin; Retrospective Studies; Stents; Thrombomodulin; Time Factors; Ventricular Function, Left

Acute myocardial infarction remains a leading cause of morbidity and mortality. While iron deficient heart failure patients are at increased risk of future cardiovascular events and see improvement with intravenous supplementation, the clinical relevance of iron deficiency in acute coronary syndrome remains unclear. We aimed to evaluate the prognostic value of iron deficiency in the acute coronary syndrome (ACS). Levels of ferritin, iron, and transferrin were measured at baseline in 836 patients with ACS. A total of 29.1% was categorized as iron deficient. The prevalence of iron deficiency was clearly higher in women (42.8%), and in patients with anemia (42.5%). During a median follow-up of 4.0 years, 111 subjects (13.3%) experienced non-fatal myocardial infarction (MI) and cardiovascular mortality as combined endpoint. Iron deficiency strongly predicted non-fatal MI and cardiovascular mortality with a hazard ratio (HR) of 1.52 (95% confidence interval (CI) 1.03-2.26;

Topics: Acute Coronary Syndrome; Aged; Anemia, Iron-Deficiency; Female; Humans; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Prevalence; Prognosis; Troponin

Successful risk stratification is necessary for optimum management of patients after acute coronary syndrome (ACS). The aim of the study was to evaluate the role of novel biochemical markers in the prediction of adverse cardiovascular events in stable patients several years after ACS.The study group was randomly selected from all ACS patients treated with reperfusion therapy between 2002 and 2003 at 1st Department of Cardiology, Medical University of Warsaw, Poland. All patients were readmitted to hospital between 2010 and 2011 for clinical and biochemical cardiovascular risk factors assessment and were prospectively observed for 30-months follow-up. The primary endpoint was all-cause death or hospital readmissions due to a cardiovascular condition at 30 months. The secondary endpoint was a composite of all-cause death or hospitalization-related noncardiovascular condition during the follow-up.The study population consisted of 146 patients (mean age 66.6 ± 9.8 years; 60 female). The primary and secondary endpoints occurred in 49 and 65 patients, respectively. Univariate analysis demonstrated that out of 17 analyzed biomarkers only high-sensitive C-reactive protein (hsCRP), Soluble Fms-Like Tyrosine kinase-1 (sFlt-1), and endothelin-1 (ET-1) were significantly associated with primary end-point and N-Terminal pro-B-type natriuretic peptide (NT-proBNP), hsCRP, ET-1, sFlt-1, and procalcitonin (PCT)-with secondary end-point. Multivariate analysis demonstrated that concentration of sFlt-1 was the only independent factor associated with primary end-point (P = .007 and P = .025, respectively), whereas NT-proBNP and hsCRP levels were only associated with secondary end-point (P = .004 and P = .001, respectively).sFlt-1, NT-proBNP, and hsCRP are associated with adverse outcomes in stable patients several years after ACS and may emerge as useful clinical biomarkers to enhance stratify patient's risk.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; C-Reactive Protein; Calcitonin; Cause of Death; Endothelin-1; Female; Follow-Up Studies; Humans; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Prospective Studies; Risk Assessment; Risk Factors; Vascular Endothelial Growth Factor Receptor-1

To investigate the changes and significance of circulating IL-39 in patients with acute coronary syndrome (ACS).. Serum IL-39 levels in ACS patients and normal coronary arteries were measured. The correlations of IL-39 with high-sensitivity CRP, cTnI, N-terminal of the prohormone brain natriuretic peptide (NTproBNP) and left ventricular ejection fraction were investigated.. The serum levels of IL-39 in ACS patients were significantly increased. IL-39 levels were positively correlated with NTproBNP, high-sensitivity CRP and cTnI, negatively correlated with left ventricular ejection fraction in ACS patients. The most significant correlation arose between serum IL-39 and NTproBNP in STEMI patients (r = 0.8309; p < 0.0001).. Circulating level of IL-39 might be a predictor of cardiac systolic dysfunction in ST-segment elevation myocardial infarction patients.

Topics: Acute Coronary Syndrome; Biomarkers; Female; Humans; Interleukins; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; ST Elevation Myocardial Infarction; Stroke Volume; Systole; Troponin I; Ventricular Dysfunction, Left

Mortality in cardiogenic shock complicating acute coronary syndrome is high, and objective risk stratification is needed for rational use of advanced therapies such as mechanical circulatory support. Traditionally, clinical variables have been used to judge risk in cardiogenic shock. The aim of this study was to assess the added value of serial measurement of soluble ST2 and amino-terminal pro-B-type natriuretic peptide to clinical parameters for risk stratification in cardiogenic shock.. CardShock (www.clinicaltrials.gov NCT01374867) is a prospective European multinational study of cardiogenic shock. The main study introduced CardShock risk score, which is calculated from seven clinical variables at baseline, and was associated with short-term mortality.. Nine tertiary care university hospitals.. Patients with cardiogenic shock caused by acute coronary syndrome (n=145).. In this substudy, plasma samples from the study patients were analyzed at eight time points during the ICU or cardiac care unit stay. Additional prognostic value of the biomarkers was assessed with incremental discrimination improvement.. The combination of soluble ST2 and amino-terminal pro-B-type natriuretic peptide showed excellent discrimination for 30-day mortality (area under the curve, 0.77 at 12 hr up to 0.93 at 5-10 d after cardiogenic shock onset). At 12 hours, patients with both biomarkers elevated (soluble ST2, ≥ 500 ng/mL and amino-terminal pro-B-type natriuretic peptide, ≥ 4,500 ng/L) had higher 30-day mortality (79%) compared to those with one or neither biomarkers elevated (31% or 10%, respectively; p < 0.001). Combined measurement of soluble ST2 and amino-terminal pro-B-type natriuretic peptide at 12 hours added value to CardShock risk score, correctly reclassifying 11% of patients.. The combination of results for soluble ST2 and amino-terminal pro-B-type natriuretic peptide provides early risk assessment beyond clinical variables in patients with acute coronary syndrome-related cardiogenic shock and may help therapeutic decision making in these patients.

Topics: Acute Coronary Syndrome; Aged; Aged, 80 and over; Biomarkers; Female; Hospitals, University; Humans; Intensive Care Units; Interleukin-1 Receptor-Like 1 Protein; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Prospective Studies; Risk Assessment; Shock, Cardiogenic

There are conflicting data on whether changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hs-CRP) concentrations between time points (delta NT-proBNP and hs-CRP) are associated with a change in prognosis.. We measured NT-proBNP and hs-CRP at 3 time points in 1665 patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). Cox proportional hazards was applied to the delta between temporal measurements to determine the continuous association with cardiovascular events. Effect estimates for delta NT-proBNP and hs-CRP are presented per 40% increase as the basic unit of temporal change.. Median NT-proBNP was 370.0 (25th, 75th percentiles, 130.0, 996.0), 340.0 (135.0, 875.0), and 267.0 (111.0, 684.0) ng/L; and median hs-CRP was 4.6 (1.7, 13.1), 1.9 (0.8, 4.5), and 1.8 (0.8, 4.4) mg/L at baseline, 30 days, and 6 months, respectively. The deltas between baseline and 6 months were the most prognostically informative. Every +40% increase of delta NT-proBNP (baseline to 6 months) was associated with a 14% greater risk of cardiovascular death (adjusted hazard ratio (HR) 1.14, 95% CI, 1.03-1.27) and with a 14% greater risk of all-cause death (adjusted HR 1.14, 95% CI, 1.04-1.26), while every +40% increase of delta hs-CRP (baseline to 6 months) was associated with a 9% greater risk of the composite end point (adjusted HR 1.09, 95% CI, 1.02-1.17) and a 10% greater risk of myocardial infarction (adjusted HR 1.10, 95%, CI 1.00-1.20).. Temporal changes in NT-proBNP and hs-CRP are quantitatively associated with future cardiovascular events, supporting their role in dynamic risk stratification of NSTEACS.. ClinicalTrials.gov identifier NCT00699998.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; C-Reactive Protein; Female; Humans; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Proteogenomics; Risk Factors; Time Factors

This study investigated roles of serum ST2, IL-33 and BNP in predicting major adverse cardiovascular events (MACEs) in acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). Blood samples were collected from the included AMI patients (n = 180) who underwent PCI. All patients were divided into the MACEs and MACEs-free groups. Enzyme-linked immunosorbent assay was performed to measure serum levels of ST2, IL-33 and BNP. Severity of coronary artery lesion was evaluated by Gensini score. Pearson correlation analysis was used. A receiver operating characteristics curve was drawn to evaluate the potential roles of ST2, IL-33 and BNP in predicting MACEs, and Kaplan-Meier curve to analyse the 1-year overall survival rate. Logistic regression analysis was conducted to analyse the independent risk factors for MACEs. Compared with the MACEs-free group, the serum levels of ST2, IL-33 and BNP were significantly higher in the MACEs group. Serum levels of ST2, IL-33 and BNP were positively correlated with each other and positively correlated with Gensini score. The area under curves of ST2, IL-33 and BNP, respectively, were 0.872, 0.675 and 0.902. The relative sensitivity and specificity were, respectively, 76.27% and 85.92%, 69.49% and 58.68%, as well as, 96.61% and 77.69%. Serum levels of ST2, IL-33 and BNP were independent risk factors for MACEs. The 1-year overall survival rate was higher in AMI patients with lower serum levels of ST2, IL-33 and BNP. In conclusion, serum levels of ST2, IL-33 and BNP have potential value in predicting MACEs in AMI patients undergoing PCI.

Topics: Acute Coronary Syndrome; Aged; Area Under Curve; Biomarkers; Coronary Vessels; Female; Gene Expression; Humans; Interleukin-1 Receptor-Like 1 Protein; Interleukin-33; Kaplan-Meier Estimate; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Percutaneous Coronary Intervention; Predictive Value of Tests; Prognosis; ROC Curve; Severity of Illness Index

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Diabetes Mellitus, Type 2; Female; Heart Failure; Hospitalization; Humans; Hypoglycemic Agents; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Peptides; Randomized Controlled Trials as Topic; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Up-Regulation

Acute coronary syndrome remains a significant problem for cardiologists. Despite improved therapy, mortality remains extremely high once CHF becomes symptomatic. Multimarker approach in cardiovascular risk prediction was proved as the most effective tool. One of the promising biomarkers is a stress-induced marker growth differentiation factor 15 (GDF-15). Purpose of the study was to improve stratification methods of CHF progression risk as a complication of ACS by studying levels of GDF-15. In our study we showed association between high level of GDF-15, determined at the first 24 hours after ACS, and CHF progression after 12 months.

Topics: Acute Coronary Syndrome; Biomarkers; Chronic Disease; Disease Progression; Female; Follow-Up Studies; Growth Differentiation Factor 15; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; ST Elevation Myocardial Infarction

Low T3 which is defined as decreased triiodothyronine (T3) and normal thyroid-stimulating hormone (TSH) and thyroxin (T4) levels is present in many acute diseases and is related to increased mortality. We studied low T3 level's relation to long-term mortality in non-ST-elevation acute coronary syndrome (NSTE-ACS) patients.. T3, T4, and TSH levels of consecutive NSTE-ACS patients were measured. Patients with normal T4 and TSH levels, but low T3 level were defined as low T3 group. Patients with normal T3, T4, and TSH levels were defined as normal group. Clinical and laboratory findings in these two groups were compared. In addition, we examined low T3 level's relation to early and long-term mortality.. Mean patient age was 61 ± 13 (67% male) and 31 (11%) patients had low T3 level. Free T3 values were negatively correlated with age, serum creatinine, and brain type natriuretic peptide values at the time of admission (r = -0.452, P < 0.0001; r = -0.255, P < 0.0001; r = -0.544, P < 0.0001, respectively). Mortality at 1 month and 1 year was higher in low T3 group (3% vs. 16%, P = 0.002; 6.4% vs. 23%, P = 0.003, respectively). In multivariate analysis, low T3 was found to be related to mortality at 1 year (OR: 2.6, 95% CI: 1.1-6.5, P = 0.02). In ROC analysis, free T3 had a good area under the curve (AUC) value for mortality at 1 year [AUC: 0.709 (95% CI: 0.619-0.799, SE: 0.0459)].. Low T3 is related to increased early and late mortality in NSTE-ACS patients. Free T3 levels may be used to identify NSTE-ACS patients with high mortality risk.

Topics: Acute Coronary Syndrome; Aged; Area Under Curve; Creatinine; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; ROC Curve; Thyrotropin; Thyroxine; Triiodothyronine

To observe the changes and evaluate the significance of serum N-terminal probrain natriuretic peptide (NT-proBNP) levels in patients with acute coronary syndrome and to discuss its clinical significance and relationship with the severity of disease.. Serum NT-proBNP levels were determined rapidly by using the triage BNP test for 98 consecutive patients with coronary heart disease (CAD) admitted to the hospital from March 2013 to December 2013; the correlation between the concentration of NT-proBNP and the degree of severity of the disease was analyzed.. The levels of NT-proBNP in the acute myocardial infarction (AMI) group were higher compared with unstable angina pectoris (UAP), stable angina pectoris (SAP), and control groups, and the levels of NT-proBNP in UAP were higher compared to the SAP and control groups. Levels of NT-proBNP in the extensive anterior wall infarction group were higher compared to that of the inferior or anteroseptal wall infarction groups: p < 0.05; the levels of NT-proBNP in the inferior wall and posterior wall infarction group were higher compared with the inferior wall infarction group and anteroseptal wall infarction group: p < 0.05; the levels of NT-proBNP in the multi-vessel group were higher than those in the single-vessel group: p < 0.05. The BNP level was positively correlated with age, heart rate, creatinine kinase-myocardial band (CK-MB), cardiac troponin T (cTnT), and blood urea nitrogen (BUN), whereas it was negatively correlated with left ventricular ejection fraction (LVEF).. NT-proBNP is related to the lowering of left ventricular ejection fraction and the severity of myocardial ischemia.
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Topics: Acute Coronary Syndrome; Adult; Biomarkers; Case-Control Studies; Cohort Studies; Echocardiography; Electrocardiography; Female; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Severity of Illness Index; Ventricular Function, Left

Chronic suppression of TSH in patients treated for differentiated thyroid carcinoma (DTC) may induce cardiac damage and increase risk for cardiovascular events and premature mortality. We aimed to compare circulating concentrations of N-terminal pro Brain Natriuretic Peptide (NT-proBNP) of DTC patients with controls, and to investigate whether higher NT-proBNP is associated with an increased risk for cardiovascular events and all-cause mortality in DTC patients.. Serum NT-proBNP levels were determined in 266 DTC patients, median 10.4 [IQR 4.1-18.5] years after DTC diagnosis, and compared to 798 age- and sex-matched controls. Using multivariable Cox regression analyses, the association of NT-proBNP with cardiovascular events and all-cause mortality was determined. Hazard ratios (HR) and 95% confidence intervals (CIs) were expressed per SD increase of log-transformed NT-proBNP.. Mean age±SD of DTC patients and controls was 54.8±14.5 and 54.8±12.8years, respectively; 74% were women. Median NT-proBNP level was 70 [40-119] ng/L for DTC patients vs. 49 [25-89] ng/L for controls (p<0.001). During median follow-up of 8.6 [6.6-9.0] years, 30 DTC patients (11.4%) had a cardiovascular event and 38 (14.4%) died. Higher NT-proBNP was associated with an increased risk for cardiovascular events and all-cause mortality, age- and sex-adjusted HRs (95% CIs) 3.22 (2.17-4.79) and 1.61 (1.17-2.23), respectively. In further models with adjustment for cardiovascular risk factors, NT-proBNP remained independently associated with outcome.. NT-proBNP levels are elevated in patients with DTC, and are associated with an increased risk for cardiovascular events and all-cause mortality. Determination of NT-proBNP may identify DTC patients at increased cardiovascular risk, who could benefit from more stringent cardiovascular risk surveillance.

Topics: Acute Coronary Syndrome; Adult; Age Factors; Aged; Biomarkers; Case-Control Studies; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Neoplasm Staging; Peptide Fragments; Prognosis; Risk Factors; Sex Factors; Survival Analysis; Thyroid Neoplasms; Thyroidectomy; Thyrotropin

N-terminal pro-brain natriuretic peptide (NT-proBNP) levels are associated with short- and long-term mortality in acute coronary syndrome (ACS). We investigated whether baseline NT-proBNP levels are associated with burden of coronary atherosclerosis assessed by SYNTAX score (SXScore). We enrolled 509 patients with ACS who underwent coronary angiography. The patients were divided into tertiles according to the SXScore: low SXScore (≤ 22), intermediate SXScore (23-32), and high SXScore (≥ 33). The NT-proBNP levels demonstrated an increase from low SXScore tertile to high SXScore tertile. The NT-proBNP levels according to the SXScore tertiles are as follows: low and intermediate (median 635 vs 1635, P = .014), low and high (median 635 vs 4568, P < .001), and intermediate and high (median 1635 vs 4568, P < .001). In multivariate analysis, NT-proBNP remained an independent predictor of high SXScore (odds ratio: 2.688, 95% confidence interval: 1.315-5.494, P = .007) together with age (P = .002), neutrophil-lymphocyte ratio (P = .017), and presence of non-ST-segment elevation ACS (P = .002). The NT-proBNP was independently associated with burden of coronary atherosclerosis in patients with ACS.

Topics: Acute Coronary Syndrome; Aged; Aged, 80 and over; Coronary Artery Disease; Female; Humans; Lymphocyte Count; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Severity of Illness Index

BNP has been extensively evaluated to determine short- and intermediate-term prognosis in patients with acute coronary syndrome, but its role in long-term mortality is not known.. To determine the very long-term prognostic role of B-type natriuretic peptide (BNP) for all-cause mortality in patients with non-ST segment elevation acute coronary syndrome (NSTEACS).. A cohort of 224 consecutive patients with NSTEACS, prospectively seen in the Emergency Department, had BNP measured on arrival to establish prognosis, and underwent a median 9.34-year follow-up for all-cause mortality.. Unstable angina was diagnosed in 52.2%, and non-ST segment elevation myocardial infarction, in 47.8%. Median admission BNP was 81.9 pg/mL (IQ range = 22.2; 225) and mortality rate was correlated with increasing BNP quartiles: 14.3; 16.1; 48.2; and 73.2% (p < 0.0001). ROC curve disclosed 100 pg/mL as the best BNP cut-off value for mortality prediction (area under the curve = 0.789, 95% CI= 0.723-0.854), being a strong predictor of late mortality: BNP < 100 = 17.3% vs. BNP ≥ 100 = 65.0%, RR = 3.76 (95% CI = 2.49-5.63, p < 0.001). On logistic regression analysis, age >72 years (OR = 3.79, 95% CI = 1.62-8.86, p = 0.002), BNP ≥ 100 pg/mL (OR = 6.24, 95% CI = 2.95-13.23, p < 0.001) and estimated glomerular filtration rate (OR = 0.98, 95% CI = 0.97-0.99, p = 0.049) were independent late-mortality predictors.. BNP measured at hospital admission in patients with NSTEACS is a strong, independent predictor of very long-term all-cause mortality. This study allows raising the hypothesis that BNP should be measured in all patients with NSTEACS at the index event for long-term risk stratification.

Topics: Acute Coronary Syndrome; Aged; Aged, 80 and over; Angina, Unstable; Biomarkers; Emergency Service, Hospital; Female; Follow-Up Studies; Glomerular Filtration Rate; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Patient Admission; Predictive Value of Tests; Prognosis; Prospective Studies; Risk Assessment; Sensitivity and Specificity; Survival Analysis; Time Factors

Altered thyroid function and increased rates of N-terminal pro-B-Type natriuretic peptide (NT-pro-BNP) are highly prevalent in coronary artery disease (CAD) patients with heart failure, and are associated with unfavorable prognosis. This study was undertaken to examine the relationship and prognostic impact of thyroid hormones, inflammatory biomarkers, and NT-pro-BNP on long-term outcomes in patients after acute coronary syndrome (ACS).. The study comprised of 642 patients (age 58 ± 10 years, 77% male) attending an in-patient cardiac rehabilitation program after experiencing ACS. Patients were evaluated for demographic, clinical and CAD risk factors as well as thyroid hormones (e.g., fT3, fT4 level, fT3/fT4 ratio), inflammatory biomarkers (hs-CRP, IL-6) and NT-pro-BNP levels. Data on fT3/fT4 ratio and NT-pro-BNP levels were not normally distributed and were natural-log transformed (ln). Both all-cause (cumulative) and cardiac-related mortality were considered the primary outcomes of interest.. According to the Cox model, age, NYHA class, (ln)NT-pro-BNP levels (HR 1.53, 95% CI 1.13-2.07), fT4 level (HR 1.15, 95% CI 1.04-1.27), and (ln)fT3/fT4 ratio (HR 0.08, 95% CI 0.02-0.32) were the most important predictors of all-cause mortality among CAD patients after ACS. Similarly, age, NYHA class, (ln)NT-pro-BNP levels (HR 1.62, 95% CI 1.11-2.36), fT4 (HR 1.15, 95% CI 1.02-1.29) and (ln)fT3/fT4 ratio (HR 0.10, 95% CI 0.02-0.55) independently predicted cardiac-related mortality. Kaplan-Meier analyses provided significant prognostic information with the highest risk for all-cause mortality in the low cut off measures of fT3/fT4 ratio <0.206 and NT-pro-BNP ≥ 290.4 ng/L (HR 2.03, 95% CI 1.39-2.96) and fT4 level >12.54 pg/ml (HR = 2.34, 95% CI 1.05-5.18). There was no association between hs-CRP, IL-6 and mortality in CAD patients after ACS.. Thyroid hormones (i.e., fT4 level and fT3/fT4 ratio) together with NT-pro-BNP level may be valuable and simple predictors of long-term outcomes of CAD patients after experiencing ACS.

Topics: Acute Coronary Syndrome; Aged; Angina Pectoris; C-Reactive Protein; Coronary Artery Disease; Female; Humans; Interleukin-6; Kaplan-Meier Estimate; Lithuania; Longitudinal Studies; Male; Middle Aged; Mortality; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Proportional Hazards Models; Prospective Studies; Thyroxine; Triiodothyronine

Whether body composition is associated with the N-terminal pro-B-type natriuretic peptide (NT-proBNP) level and its prognostic performance in acute coronary syndrome (ACS) remains unknown. We aimed to investigate the influence of body composition on the NT-proBNP level and its prognostic performance among ACS patients.. In total, 1623 ACS patients with NT-proBNP data were enrolled. Percent body fat and lean mass index were estimated using the Clínica Universidad de Navarra-Body Adiposity Estimator equation. Patients were divided into three groups according to the tertiles of sex-specific body mass index, percent body fat, or lean mass index. The endpoints were death from any cause and cardiovascular death.. Body mass index was inversely correlated with NT-proBNP levels (β = -0.036, P = 0.003). Lean mass index, but not percent body fat, was inversely associated with NT-proBNP levels (β of lean mass index = -0.692, P = 0.002). During a median follow-up of 23 months, 161 all-cause deaths occurred, and of these, 93 (57.8 %) were attributed to cardiovascular causes. Multivariate Cox analysis showed that the NT-proBNP level independently predicted all-cause mortality or cardiovascular death in the lower body mass index, lean mass index, and percent body fat groups. However, the prognostic performance of NT-proBNP was attenuated in patients with high body mass index, lean mass index, and percent body fat. In the subgroup of patients with diabetes, inverse associations between NT-proBNP levels and body mass index or body composition were not observed. In addition, the negative influence of high body mass index and body composition on the prognostic performance of the NT-proBNP level appeared to be attenuated.. Body mass index and lean mass index, but not percent body fat, are inversely associated with NT-proBNP levels. The prognostic performance of this biomarker may be compromised in patients with high body mass index, percent body fat, or lean mass index. Additionally, the influence of body composition on the NT-proBNP level and its prognostic performance might be attenuated in diabetic patients with ACS.

Topics: Acute Coronary Syndrome; Aged; Aged, 80 and over; Biomarkers; Body Composition; Cohort Studies; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Obesity; Predictive Value of Tests; Prognosis; Risk Factors

Several biomarkers have been shown to improve risk stratification in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS); however, they have not been integrated into risk prediction tools.. C-reactive-protein, N-terminal-pro-brain natriuretic peptide (NT-proBNP), and haemoglobin A1C were measured in 6447 patients with NSTEACS who were enrolled in the Clopidogrel in Unstable Angina to Prevent Recurrent Events trial. A risk score to predict cardiovascular (CV) death, myocardial infarction (MI), or stroke at 1 year was developed by incorporating biomarkers that were independently predictive of events with traditional variables, electrocardiogram, and troponin-T. Model discrimination was evaluated using c-statistic, integrated discrimination improvement, and net reclassification index, and validated using bootstrap methods.. During 1 year of follow-up, 686 patients experienced a CV event. Each biomarker predicted CV death, MI, or stroke; however, only NT-proBNP and haemoglobin A1C improved model discrimination, increasing the c-statistic (0.66-0.71), integrated discrimination improvement to 3.4%, and net reclassification index to 17.5% (P < 0.0001 for all measures). A risk score ranging from 0 to 20 points including variables for age, prior MI/stroke, sex, ST-segment deviation, troponin-T, NT-proBNP, and haemoglobin A1C classified individuals into low-, intermediate-, and high-risk groups with rates of CV death, MI, stroke of 3.7%, 9.1%, 17.8%, respectively. The absolute benefit of dual antiplatelet therapy vs aspirin alone was 1.0%, 4.7%, and 3.0% in low-, intermediate-, and high-risk groups, respectively.. The addition of NT-proBNP and haemoglobin A1C to 5 standard variables creates a 7-variable risk score that improves prediction of CV events at 1 year and aids in risk-based selection of patients with NSTEACS for dual antiplatelet therapy.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; C-Reactive Protein; Drug Therapy, Combination; Female; Follow-Up Studies; Glycated Hemoglobin; Humans; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Platelet Aggregation Inhibitors; Risk Assessment; Stroke; Troponin T

The endogenous amino acid homoarginine predicts mortality in cerebro- and cardiovascular disease. The objective was to explore whether homoarginine is associated with atrial fibrillation (AF) and outcome in patients with acute chest pain.. One thousand six hundred forty-nine patients with acute chest pain were consecutively enrolled in this study, of whom 589 were diagnosed acute coronary syndrome (ACS). On admission, plasma concentrations of homoarginine as well as brain natriuretic peptide (BNP), and high-sensitivity assayed troponin I (hsTnI) were determined along with electrocardiography (ECG) variables. During a median follow-up of 183 days, 60 major adverse cardiovascular events (MACEs; 3.8%), including all-cause death, myocardial infarction, or stroke, were registered in the overall study population and 43 MACEs (7.5%) in the ACS subgroup. Adjusted multivariable Cox regression analyses revealed that an increase of 1 SD of plasma log-transformed homoarginine (0.37) was associated with a hazard reduction of 26% (hazard ratio [HR], 0.74; 95% CI, 0.57-0.96) for incident MACE and likewise of 35% (HR, 0.65; 95% CI, 0.49-0.88) in ACS patients. In Kaplan-Meier survival curves, homoarginine was predictive for patients with high-sensitivity assayed troponin I (hsTnI) above 27 ng/L (P<0.05). Last, homoarginine was inversely associated with QTc duration (P<0.001) and prevalent AF (OR, 0.83; 95% CI, 0.71-0.95).. Low plasma homoarginine was identified as a risk marker for incident MACEs in patients with acute chest pain, in particular, in those with elevated hsTnI. Impaired homoarginine was associated with prevalent AF. Further studies are needed to investigate the link to AF and evaluate homoarginine as a therapeutic option for these patients.

Topics: Acute Coronary Syndrome; Acute Pain; Aged; Atrial Fibrillation; Biomarkers; Chest Pain; Female; Homoarginine; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Prognosis; Proportional Hazards Models; Stroke

Acute heart failure negatively affects short-term outcomes of patients with acute coronary syndrome (ACS). Therefore, reliable and non-invasive assessment of pulmonary congestion is needed to select patients requiring more intensive monitoring and therapy. Since plasma levels of natriuretic peptides are influenced by myocardial ischemia, they might not reliably reflect congestion in the context of ACS. The novel endothelial biomarker, soluble CD146 (sCD146), presents discriminative power for detecting the cardiac origin of acute dyspnea similar to that of natriuretic peptides and is associated with systemic congestion. We evaluated the performance of sCD146 for the assessment of pulmonary congestion in the early phase of ACS.. One thousand twenty-one consecutive patients with ACS were prospectively enrolled. Plasma levels of sCD146, brain natriuretic peptide (BNP), and high-sensitive troponin T were measured within 24 hr after the onset of chest pain. Pulmonary congestion on chest radiography was determined and classified in three groups according to the degree of congestion.. Nine hundred twenty-seven patients with ACS were analyzed. Ninety-two (10%) patients showed signs of pulmonary edema on chest radiography. Plasma levels of sCD146 reflected the radiological severity of pulmonary congestion. Higher plasma levels of sCD146 were associated with the worse degree of pulmonary congestion. In contrast to BNP, sCD146 levels were not affected by the level of troponin T.. The novel endothelial biomarker, sCD146, correlates with radiological severity of pulmonary congestion in the early phase of ACS and, in contrast to BNP, is not affected by the amount of myocardial cell necrosis.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; CD146 Antigen; Chest Pain; Electrocardiography; Enzyme-Linked Immunosorbent Assay; Female; Humans; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Severity of Illness Index; Troponin T

Risk scores and cardiac biomarker tests allow clinicians to accurately diagnose acute coronary syndrome (ACS) and perform early risk stratification. However, few investigations have evaluated the use of these risk scores and biomarkers for predicting risk of cardiovascular events in drug-eluting stent (DES) era.. This prospective cohort study included 861 patients with ACS. Three risk scores-Global Registry of Acute Coronary Events (GRACEs), Platelet glycoprotein IIb/IIIa in Unstable angina: Receptor Suppression Using Integrilin, and Thrombolysis In Myocardial Infarction-and levels of four biomarkers-N-terminal pro-B-type natriuretic peptide (NT pro-BNP), high-sensitivity troponin T, heart-fatty acid binding protein, and high-sensitivity C-reactive protein-were recorded on admission. Major adverse cardiac events (MACE) (death, cardiovascular events) were evaluated at 30-day and 1-year follow-up.. At 30-day follow-up, there were 23 (3.1%) deaths from cardiovascular events and 4 (0.5%) cerebral accidents. NT pro-BNP levels and GRACE score were strong MACE predictors, with adjusted odds ratios (ORs) (95% CI) of 2.90 (1.63-5.20) and 1.01 (1.00-1.02), respectively, in logistic model. The C-statistic of NT pro-BNP (0.77; 95% CI, 0.67-0.86) was similar to that of GRACE score (0.76; 95% CI, 0.66-0.87); however, the combined C-statistic was higher (0.81), yielding a net reclassification improvement of 13% (p<0.01). At 1-year follow-up, there were 51 (6.8%) deaths and 10 (1.3%) cerebral accidents.. In the DES era, GRACE score and biomarkers can still predict major cardiac events in patients with ACS for both acute and long-term prognoses.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Cohort Studies; Death; Drug-Eluting Stents; Fatty Acid-Binding Proteins; Female; Follow-Up Studies; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prospective Studies; Risk Assessment

Currently, there are no studies addressing the influence of age on the prognostic information of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in Asian population with acute coronary syndrome (ACS). The purpose of this study was to investigate the prognostic performance of NT-proBNP in Chinese patients with ACS across different age groups. A total of 1512 ACS patients with venous blood NT-proBNP measured were enrolled. Patients were divided into tertiles based on their ages (<61, 61-71, ≥72 years). The median NT-proBNP concentrations in the three groups (T1-T3) were 406, 573, and 1288 pg/ml (p < 0.001), respectively. During a median follow-up of 23 months, 150 all-cause deaths occurred, and 88 (58.7 %) were attributed to cardiovascular cause. NT-proBNP levels are independently associated with mortality in each age group [1st group: HR 2.19 95 % CI (1.17-4.10); 2nd group: HR 1.82 95 % CI (1.04-3.20); 3rd group: HR 1.48 95 % CI (1.09-2.01), P interaction = 0.062]. NT-proBNP improves discrimination and reclassification for mortality beyond thrombolysis in myocardial infarction score in patients of all ages. The optimal NT-proBNP cutoff points for predicting mortality in three age groups are 1511, 2340, and 2883 pg/ml, respectively. In conclusion, NT-proBNP is a valuable biomarker in predicting long-term mortality and provides an improvement in discrimination and reclassification for prognosis in ACS patients of all ages.

Topics: Acute Coronary Syndrome; Age Factors; Aged; Aged, 80 and over; Asian People; Atrial Natriuretic Factor; Biomarkers; Chi-Square Distribution; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Prognosis; Protein Precursors; Risk Factors

Amino-terminal pro-B type natriuretic peptide (NT-proBNP) is a well-established prognostic factor in heart failure (HF). However, numerous causes may lead to elevations in NT-proBNP, and thus, an increased NT-proBNP level alone is not sufficient to predict outcome. The aim of this study was to evaluate the utility of two acute response markers, high sensitivity C-reactive protein (hsCRP) and heart-type fatty acid binding protein (H-FABP), in patients with an increased NT-proBNP level.. The 278 patients were classified into three groups by etiology: 1) acute coronary syndrome (ACS) (n=62), 2) non-ACS cardiac disease (n=156), and 3) infectious disease (n=60). Survival was determined on day 1, 7, 14, 21, 28, 60, 90, 120, and 150 after enrollment.. H-FABP (P<0.001), NT-proBNP (P=0.006), hsCRP (P<0.001) levels, and survival (P<0.001) were significantly different in the three disease groups. Patients were divided into three classes by using receiver operating characteristic curves for NT-proBNP, H-FABP, and hsCRP. Patients with elevated NT-proBNP (≥3,856 pg/mL) and H-FABP (≥8.8 ng/mL) levels were associated with higher hazard ratio for mortality (5.15 in NT-proBNP and 3.25 in H-FABP). Area under the receiver operating characteristic curve analysis showed H-FABP was a better predictor of 60-day mortality than NT-proBNP.. The combined measurement of H-FABP with NT-proBNP provides a highly reliable means of short-term mortality prediction for patients hospitalized for ACS, non-ACS cardiac disease, or infectious disease.

Topics: Acute Coronary Syndrome; Aged; Area Under Curve; Biomarkers; C-Reactive Protein; Fatty Acid Binding Protein 3; Fatty Acid-Binding Proteins; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Proportional Hazards Models; ROC Curve

Diseases of the cardiovascular system is one of the most common causes of death among people over 65 years. Due to its course and incidence are a major cause of disability and impaired quality of life for seniors, as well as a serious economic problem in health care. Important role in the prevention of cardiovascular disease plays making systematic physical activity, which is a component of any rehabilitation program. Regular physical training by doing cardio-and vasoprotective has a beneficial effect on cardiovascular status and physical performance in patients with diagnosed coronary heart disease, regardless of age.. The aim of this study was to evaluate the effect of controlled exercise on selected biochemical parameters and functional myocardial infarction.. A group of 89 patients were divided into 3 subgroups. In group I (n = 30) was performed 2 weeks cardiac rehabilitation program, in group II (n = 30) 4 weekly. Streamline the program consisted of a series of interval training performed using a bicycle ergometer and general exercise. The remaining group (gr. III, n = 29) participated in individually selected training program. In all subjects before and after the training cycle underwent thoracic impedance plethysmography, also determined the level of plasma natriuretic peptide NT-proBNP and echocardiography and exercise test.. After training, in groups, which carried out a controlled physical training, improvement was observed: exercise capacity of patients respectively in group I (p = 0.0003), group II (p = 0.0001) and group III (p = 0.032), stroke volume SV, cardiac output CO and global myocardial contractility, there was also reduction in the concentration of natriuretic peptide NT-proBNP. Furthermore, the correlation between the results shown pletyzmography parameters and NT-proBNP, SV, CO and EF.. Regular physical training as part of the cardiac rehabilitation has a beneficial effect on biochemical parameters and functional myocardial infarction in patients with ACS. Size of the observed changes conditioned by the nature and duration of the training.

Topics: Acute Coronary Syndrome; Adult; Aged; Cardiography, Impedance; Exercise Test; Exercise Therapy; Female; Heart; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments

Natriuretic peptides are the standard biomarker for risk stratification in cardiovascular disease. Novel biomarkers of cardiovascular stress might allow refinement in risk stratification for patients with acute coronary syndrome (ACS). We tested the performance of these novel biomarkers for cardiovascular risk stratification in patients who presented with ACS.. In the AtheroGene study, 873 patients presented with ACS in the emergency department. Biomarkers measured were: B-type natriuretic peptide (BNP), N-terminal pro BNP (NT-proBNP), midregional proatrial natriuretic peptide, midregional proadrenomedullin (MR-proADM), copeptin, and troponin I. The median follow-up time was 4 years and during this time 50 patients died from cardiac causes.. Cox regression analysis for the continuous variables NT-proBNP and BNP showed a hazard ratio (HR) of 1.9 and 1.8, respectively, for 1 SD increase (P < 0.001 and P = 0.003) in the fully adjusted model. Novel biomarkers with MR-proADM had an HR of 3.2, followed by midregional proatrial natriuretic peptide with an HR of 1.9 (both P < 0.001), and copeptin with an HR of 1.6 (P < 0.001). C-index revealed MR-proADM as the best discriminator for identifying patients with the outcome with a C-index = 0.8, and C-index was 0.72 for NT-proBNP (P for comparison = 0.017). Integrated discrimination improvement for MR-proADM was 0.059 compared with NT-proBNP (P = 0.016), thus providing background that MR-proADM was better to identify persons with the outcome. Troponin I levels at the time of admission were not significant for risk stratification.. In patients who present with ACS the novel biomarker, MR-proADM was the best predictor for outcome. MR-proADM adds modest information and is useful for risk prediction in ACS patients.

Topics: Acute Coronary Syndrome; Adrenomedullin; Aged; Biomarkers; Cardiovascular System; Chest Pain; Female; Germany; Glycopeptides; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Proportional Hazards Models; Protein Precursors; Reproducibility of Results; Risk Assessment; Stress, Physiological; Troponin I

Inflammatory markers have been identified as potential indicators of future adverse outcome after acute cardiac events.. This study aimed to analyze baseline inflammatory cytokines levels in patients with acute heart failure (AHF) and/or acute coronary syndrome (ACS) according to survival. The main objective was to identify risk factors for mortality after an episode of AHF and/or ACS.. In this prospective longitudinal study 75 patients with the diagnosis of AHF and/or ACS were enrolled. Baseline laboratory and clinical data were retrieved. Serum and urine interleukin-6 (IL-6) and interleukin-18 (IL-18) levels, plasma B-type natriuretic peptide (BNP) and serum cystatin C values were determined. The primary outcome was in-hospital mortality while secondary outcome was six-month mortality.. Median serum and urine IL-6 levels, serum and urine IL-18 levels, as well as median concentrations of plasma BNP and serum cystatin C, were significantly increased in deceased in comparison to surviving AHF and/or ACS patients. Univariate Cox regression analysis identified serum IL-6, serum IL-18, urine IL-6, urine IL-18 as well as serum cystatin C and Acute Physiology and Chronic Health Evaluation (APACHE) II score as risk factors for mortality after an episode of AHF and/or ACS. Multivariate Cox regression analysis revealed that only serum IL-6 is the independent risk factor for mortality after acute cardiac events (HR 61.7, 95% CI 2.1-1851.0; p=0.018).. Present study demonstrated the strong prognostic value of serum IL-6 in predicting mortality of patients with AHF and/or ACS.

Topics: Acute Coronary Syndrome; Acute Disease; Aged; Biomarkers; Cytokines; Female; Heart Failure; Humans; Interleukin-18; Interleukin-6; Longitudinal Studies; Male; Middle Aged; Natriuretic Peptide, Brain; Prospective Studies; Risk Factors; Survival Rate

The propeptide of brain natriuretic peptide (ProBNP) is used for the diagnosis of left ventricle dysfunction and heart failure. In patients with an Acute Coronary Syndrome (ACS) it can contribute to both short and long term prognosis of cardiovascular events that could be very important for management and therapy of these patients.. The aim of this study was to evaluate the prognostic value of ProBNP for the clinical course after an acute coronary syndrome, compared with that of cardiac troponine T (cTnT) and the risk stratification of patients with acute coronary syndrome, both during hospitalization and six months later.. We studied 390 patients (256 men, 134 women, mean age 66.04+12.38) with an acute coronary syndrome who were hospitalized in the Coronary Unit of our cardiology clinic. We studied epidemiological and clinical data and biochemical markers were examined as prognostic factors for clinical course intrahospital and during six months follow-up.. In the majority of patients, a myocardial infarction without ST elevation was diagnosed (NSTEMI) (193 patients 49.49%) while 167 patients (42.82%) had a myocardial infarction with ST elevation (STEMI) and the remaining 30 patients (7.69%) had unstable angina. Patients had multiple risk factors for coronary heart disease. The levels of ProBNP were significantly elevated in patients with STEMI (p=0.003) and NSTEMI (p=0.002) who died or experienced an adverse event (angina, myocardial infarction, cardiogenic shock, congestive heart failure, arrhythmias) during hospitalization. After six months of follow-up, patients who had an adverse event had higher levels of ProBNP. There was no difference in troponine T levels in patients with STEMI and NSTEMI who had adverse events compared with the others, either during hospitalization or after six months.. The level of ProBNP is an important predictor of cardiovascular events in patients with acute coronary syndrome. This study showed that it provides better predictive power than the troponine T.

Topics: Acute Coronary Syndrome; Aged; Angina, Unstable; Female; Hospitalization; Humans; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Predictive Value of Tests; Prognosis; Prospective Studies; Risk Factors; Troponin T

The biomarker N-terminal pro-brain natriuretic peptide (NT-proBNP) predicts outcome in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS). Whether NT-proBNP has incremental prognostic value beyond established risk strategies is still questionable.. To evaluate the predictive value of NT-proBNP for 30-day mortality over and beyond the Global Registry of Acute Coronary Events (GRACE) and Thrombolysis In Myocardial Infarction (TIMI) risk scores in patients with NSTE-ACS.. Patients included in our ACS registry were candidates. NT-proBNP levels on admission were measured and the GRACE and TIMI risk scores were assessed. We compared the predictive value of NT-proBNP to both risk scores and evaluated whether NT-proBNP improves prognostication by using receiver operator curves and measures of discrimination improvement.. In patients with NSTE-ACS, NT-proBNP and the GRACE risk score (but not the TIMI risk score) both have good and comparable predictive value for 30-day mortality. However, incremental prognostic value of NT-proBNP beyond the GRACE risk score could not be demonstrated.

Topics: Acute Coronary Syndrome; Aged; Aged, 80 and over; Area Under Curve; Biomarkers; Coronary Angiography; Decision Support Techniques; Female; Humans; Logistic Models; Male; Middle Aged; Natriuretic Peptide, Brain; Non-ST Elevated Myocardial Infarction; Odds Ratio; Peptide Fragments; Predictive Value of Tests; Prognosis; Registries; Retrospective Studies; Risk Assessment; Risk Factors; ROC Curve; Time Factors

It remained unclear whether the combination of the Canada Acute Coronary Syndrome Risk Score (CACS-RS) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) could have a better performance in predicting clinical outcomes in acute ST-elevation myocardial infarction (STEMI) patients with primary percutaneous coronary intervention.. A total of 589 consecutive STEMI patients were enrolled. The potential additional predictive value of NT-pro-BNP with the CACS-RS was estimated. Primary endpoint was in-hospital mortality and long-term poor outcomes.. The incidence of in-hospital death was 3.1%. Patients with higher NT-pro-BNP and CACS-RS had a greater incidence of in hospital death. After adjustment for the CACS-RS, elevated NT-pro-BNP (defined as the best cutoff point based on the Youden's index) was significantly associated with in hospital death (odd ratio = 4.55, 95%CI = 1.52-13.65, p = 0.007). Elevated NT-pro-BNP added to CACS-RS significantly improved the C-statistics for in-hospital death, as compared with the original score (0.762 vs. 0.683, p = 0.032). Furthermore, the addition of NT-pro-BNP to CACS-RS enhanced net reclassification improvement (0.901, p < 0.001) and integrated discrimination improvement (0.021, p = 0.033), suggesting effective discrimination and reclassification. In addition, the similar result was also demonstrated for in-hospital major adverse clinical events (C-statistics: 0.736 vs. 0.695, p = 0.017) or 3-year mortality (0.699 vs. 0.604, p = 0.004).. Both NT-pro-BNP and CACS-RS are risk predictors for in hospital poor outcomes in patients with STEMI. A combination of them could derive a more accurate prediction for clinical outcome s in these patients.

Topics: Acute Coronary Syndrome; Biomarkers; China; Electrocardiography; Follow-Up Studies; Incidence; Natriuretic Peptide, Brain; Peptide Fragments; Percutaneous Coronary Intervention; Predictive Value of Tests; Prognosis; Retrospective Studies; Risk Assessment; ROC Curve; ST Elevation Myocardial Infarction; Survival Rate; Time Factors

With increasing life expectancy in the western world, the aging population will compose a significant portion of the demographic. Notably, cardiovascular disease is particularly prevalent in the elderly population. The aim of the present study is to investigate the outcomes of octogenarians referred for urgent coronary angiography in the setting of acute coronary syndromes (ACS).. Between June 2007 and June 2012, consecutive patients with ACS were referred for evaluation and percutaneous intervention. Subsequently, the in-hospital death and major adverse cardiovascular events (MACE) at 30 days were analyzed. Multivariate analysis was performed to identify the predictors for death and MACE.. In patients ≥80 years (n = 296) ST-segment elevation myocardial infarction (STEMI) occurred in 46.6%, non-ST-segment elevation myocardial infarction (NSTEMI) in 45.9%, and 7.4% had unstable angina. On the other hand, in patients <80 years (n = 2,316) STEMI was observed in 53.4%, NSTEMI in 37.8% and unstable angina in 9.0%. The primary end-point of total mortality was significantly higher in octogenarians (7.4 vs. 4.5%, p = 0.026). Similarly, the secondary end-point comprising overall MACE rate was significantly higher among the elderly (12.5 vs. 7.3%, p = 0.002). Within the group of octogenarians, no relation between age and outcomes was noted (for death: OR 0.99, 95% CI 0.84-1.16, p = 0.915; and for MACE: OR 1.10, 95% CI 0.88-1.36, p = 0.412); however, in patients <80 years, age was related to outcomes (for death: OR 1.05, 95% CI, 1.02-1.08, p = 0.003; and for MACE: OR 1.03, 95% CI, 1.01-1.05, p = 0.011). In a multivariate analysis, systolic blood pressure (OR 0.97 95% CI 0.94-0.99, p = 0.0058), maximal value of creatine kinase (OR 1.00, 95% CI 1.00-1.00, p = 0.033), and maximal value of NT-proBNP (OR 1.00, 95% CI 1.00-1.00, p = 0.0225) were independent predictors for death, while systolic blood pressure (OR 0.98, 95% CI 0.96-0.99, p = 0.0384) and maximal value of C-reactive protein (OR 1.01, 95% CI 1.00-1.01, p = 0.0265) were associated with overall MACE.. Here we confirm that in-hospital death and MACE rate remain significantly elevated in octogenarians in spite of implementation of modern therapies. However, our real-world registry strongly suggests that early revascularization appears safe and effective in elderly patients. Furthermore, we have identified that systolic blood pressure, creatine kinase, NT-proBNP, and C-reactive protein are strong predictors for outcomes in octogenarians.

Topics: Acute Coronary Syndrome; Aged, 80 and over; Angina, Unstable; Biomarkers; Blood Pressure; C-Reactive Protein; Chi-Square Distribution; Coronary Angiography; Creatine Kinase; Female; Hospital Mortality; Humans; Kaplan-Meier Estimate; Logistic Models; Male; Middle Aged; Multivariate Analysis; Myocardial Infarction; Natriuretic Peptide, Brain; Odds Ratio; Peptide Fragments; Percutaneous Coronary Intervention; Predictive Value of Tests; Referral and Consultation; Registries; Retrospective Studies; Risk Assessment; Risk Factors; Tertiary Care Centers; Time Factors; Treatment Outcome

We have lately documented the importance of N-terminal pro-brain natriuretic peptide in aiding the diagnosis of Kawasaki disease.. We sought to investigate the potential value of N-terminal pro-brain natriuretic peptide pertaining to the prediction of coronary artery dilatation (Z-score>2.5) and/or of resistance to intravenous immunoglobulin therapy. We hypothesised that increased serum N-terminal pro-brain natriuretic peptide level correlates with increased coronary artery dilatation and/or resistance to intravenous immunoglobulin.. We carried out a prospective study involving newly diagnosed patients treated with 2 g/kg intravenous immunoglobulin within 5-10 days of onset of fever. Echocardiography was performed in all patients at onset, then weekly for 3 weeks, then at month 2, and month 3. Coronary arteries were measured at each visit, and coronary artery Z-score was calculated. All the patients had N-terminal pro-brain natriuretic peptide serum level measured at onset, and the Z-score calculated.. There were 109 patients enrolled at 6.58±2.82 days of fever, age 3.79±2.92 years. High N-terminal pro-brain natriuretic peptide level was associated with coronary artery dilatation at onset in 22.2 versus 5.6% for normal N-terminal pro-brain natriuretic peptide levels (odds ratio 4.8 [95% confidence interval 1.05-22.4]; p=0.031). This was predictive of cumulative coronary artery dilatation for the first 3 months (p=0.04-0.02), but not during convalescence at 2-3 months (odds ratio 1.28 [95% confidence interval 0.23-7.3]; p=non-significant). Elevated N-terminal pro-brain natriuretic peptide levels did not predict intravenous immunoglobulin resistance, 15.3 versus 13.5% (p=1).. Elevated N-terminal pro-brain natriuretic peptide level correlates with acute coronary artery dilatation in treated Kawasaki disease, but not with intravenous immunoglobulin resistance.

Topics: Acute Coronary Syndrome; Biomarkers; Child; Child, Preschool; Coronary Vessels; Echocardiography; Female; Humans; Immunoglobulins, Intravenous; Infant; Male; Mucocutaneous Lymph Node Syndrome; Natriuretic Peptide, Brain; Prospective Studies

Topics: Acute Coronary Syndrome; Humans; Natriuretic Peptide, Brain; Prognosis; Risk Assessment

Despite the availability of high-sensitive troponin (hs-cTnT), there is still room for improvement in the diagnostic assessment of patients suspected of acute coronary syndrome (ACS). Apart from serial biomarker testing, which is time-consuming, novel biomarkers like copeptin have been proposed to expedite the early diagnosis of suspected ACS in addition to hs-cTnT. We determined whether placenta derived growth factor (PlGF), soluble Fms-like tyrosine kinase 1 (sFlt-1), myoglobin, N-terminal prohormone B-type Natriuretic Peptide (NT-proBNP), growth-differentiation factor 15 (GDF-15) and copeptin improved early assessment of chest pain patients.. This prospective, single centre diagnostic FAME-ER study included patients presenting to the ED with symptoms suggestive of ACS. Blood was collected to measure biomarkers, notably, hs-cTnT was retrospectively assessed. Added value of markers was judged by increase in AUC using multivariable logistic regression.. Of 453 patients enrolled, 149 (33%) received a final diagnosis of ACS. Hs-cTnT had the highest diagnostic value in both univariable and multivariable analysis. PPVs of the biomarkers ranged from 23.5% (PlGF) to 77.9% (hs-cTnT), NPVs from 67.0% (PlGF) to 86.4% (hs-cTnT). Only myoglobin yielded diagnostic value in addition to clinical symptoms and electrocardiography (ECG) (AUC of clinical model 0.80) with AUC of 0.84 (p<0.001). However, addition of hs-cTnT was superior (AUC 0.89, p<0.001). Addition of the biomarkers to our clinical model and hs-cTnT did not or only marginally (GDF-15) improved diagnostic performance.. When assessing patients suspected of ACS, only myoglobin had added diagnostic value beyond clinical symptoms and ECG. However, when combined with hs-cTnT, it yields no additional diagnostic value. PlGF, sFlt-1, NT-proBNP, GDF-15 and copeptin had no added value to the clinical model or hs-cTnT.

Topics: Acute Coronary Syndrome; Aged; Area Under Curve; Biomarkers; Electrocardiography; Female; Glycopeptides; Growth Differentiation Factor 15; Humans; Logistic Models; Male; Middle Aged; Natriuretic Peptide, Brain; Odds Ratio; Peptide Fragments; Placenta Growth Factor; Pregnancy Proteins; Prospective Studies; ROC Curve; Sensitivity and Specificity; Troponin T; Vascular Endothelial Growth Factor Receptor-1

Gender differences in patients presenting with suspected acute coronary syndromes (ACS) have not yet been fully characterized. The aim of this study was to assess gender-related disparities in clinical profiles, biomarkers and diagnoses of patients with suspected ACS.. This single-centre, prospective cohort study included 377 consecutive patients presenting with suspected ACS to the emergency department. Suspected ACS was defined as a request for conventional troponin T (c-cTnT) measurements on clinical grounds.. Women were older than men (p = 0.004), and had a lower prevalence of known coronary artery and peripheral vascular disease (p < 0.05). c-cTnT was positive in 8% of female and in 14% of male patients (p = 0.16), TIMI risk score and cardiac biomarkers including c-cTnT, hs-cTnT, myoglobin, creatine kinase, N-terminal pro-brain natriuretic peptide, myeloid-related protein 8/14 and pregnancy-associated plasma protein A were lower in women (p < 0.05). Women were less frequently diagnosed with ACS (30 vs. 51%), and were not referred for urgent coronary angiography as often as men (p < 0.001). In multivariate analysis, female gender was associated with a lower referral for coronary angiography (HR 0.41, 95% CI 0.23-0.78, p = 0.006).. In patients with suspected ACS, women presented with different biomarker profiles, and were less often diagnosed with ACS and referred to coronary angiography.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Coronary Angiography; Creatine Kinase; Emergency Service, Hospital; Female; Germany; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Myoglobin; Natriuretic Peptide, Brain; Pain Measurement; Prospective Studies; Sex Factors; Troponin T

To investigate the long-term prognostic significance of baseline plasma IL-8 levels in a group of well-characterized male patients presenting with acute coronary syndrome.. IL-8 is a cytokine that has been implicated in the pathogenesis of atherosclerosis and acute coronary syndrome. Elevated plasma levels have been reported in patients with acute coronary syndrome.. Baseline plasma IL-8 levels were measured in 180 male patients with acute coronary syndrome who were referred for coronary angiography and followed prospectively for the development of all-cause mortality for 5 years.. In a multivariate model that included a wide variety of baseline clinical, laboratory and angiographic parameters in the selection process, baseline plasma IL-8 levels (analyzed as a continuous variable) emerged as a significant predictor of all-cause mortality at 5 years (HR, 1.43; 95% CI, 1.08-1.88; p = 0.0123). Furthermore, in 3 additional multivariate models that also included in the selection process a number of contemporary biomarkers with established prognostic efficacy in ACS (i.e., NT-proBNP, hs-CRP, hemoglobin and RDW), IL-8 remained an independent predictor of all-cause mortality at 5 years.. Elevated baseline plasma levels of IL-8 are associated with an increased risk of long-term all-cause mortality in patients with acute coronary syndrome. Furthermore, this association is independent of a variety of clinical, laboratory and angiographic variables, including contemporary biomarkers with established prognostic efficacy in acute coronary syndrome.

Topics: Acute Coronary Syndrome; Age Factors; Aged; Atherosclerosis; Biomarkers; C-Reactive Protein; Coronary Angiography; Coronary Artery Disease; Erythrocytes; Follow-Up Studies; Glomerular Filtration Rate; Heart Failure; Hemoglobins; Humans; Interleukin-8; Kaplan-Meier Estimate; Male; Middle Aged; Mortality; Multivariate Analysis; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Prospective Studies; Renal Insufficiency

This study aims to analyze the clinical significance of the measuring B-type natriuretic peptide (BNP) and stress glycemia in patients with acute coronary syndrome (ACS), and to investigate the relationships between the two biomarkers and the severity of coronary artery lesions. One hundred and five consecutive patients with ACS admitted for coronary artery angiography were divided into three clinical subgroups. These patients were then further assigned into either of three subgroups according to their Gensini score. Moreover, a group of patients with stable angina (SA) and those with no history of coronary disease served as controls. The patients' BNP levels were analyzed on admission and their fasting blood glucose was measured the next morning. BNP and fasting blood glucose concentrations were highly elevated in patients with ACS irrespective of their subgroups compared to SA and control patients. This observation was statistically significant (P < 0.001). Further, the concentrations of BNP and fasting blood glucose between the three ACS subgroups were significantly different (P < 0.001) depending on the severity of the coronary artery disease. There is a positive correlation between levels of BNP and blood glucose concentration and Gensini score in ACS patients (r = 0.782, P < 0.05, r = 0.732, P < 0.05). BNP level and stress glycemia were significantly higher in ACS patients than those in SA and control groups. There is a correlation between BNP level and stress blood glucose concentration and the severity of coronary artery lesions. Combined analysis of BNP and stress blood glucose can be helpful and effective for risk stratification of patients with ACS after admission.

Topics: Acute Coronary Syndrome; Adult; Aged; Aged, 80 and over; Angina, Stable; Blood Glucose; Coronary Angiography; Coronary Artery Disease; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Stress, Physiological

To investigate whether admission B-type natriuretic peptide levels predict the development of acute kidney injury in acute coronary syndromes.. Prospective study.. Single-center study, 13-bed intensive cardiac care unit at a University Cardiological Center.. Six-hundred thirty-nine acute coronary syndromes patients undergoing emergency and urgent percutaneous coronary intervention.. None.. We measured B-type natriuretic peptide at hospital admission in acute coronary syndromes patients (55% ST-elevation myocardial infarction and 45% non-ST-elevation myocardial infarction). Acute kidney injury was classified according to the Acute Kidney Injury Network criteria: stage 1 was defined as a serum creatinine increase greater than or equal to 0.3 mg/dL from baseline; stage 2 as a serum creatinine increase greater than two- to three-fold from baseline; stage 3 as a serum creatinine increase greater than three-fold from baseline, or greater than or equal to 4.0 mg/dL with an acute increase greater than 0.5 mg/dL, or need for renal replacement therapy. Acute kidney injury was developed in 85 patients (13%) and had a higher in-hospital mortality than patients without acute kidney injury (14% vs 1%; p < 0.001). B-type natriuretic peptide levels were higher in acute kidney injury patients than in those without acute kidney injury (264 [112-957] vs 98 [44-271] pg/mL; p < 0.001) and showed a significant gradient according to acute kidney injury severity (224 [96-660] pg/mL in stage 1 and 939 [124-1,650] pg/mL in stage 2-3 acute kidney injury; p < 0.001). The risk of developing acute kidney injury increased in parallel with B-type natriuretic peptide quartiles (5%, 9%, 15%, and 24%, respectively; p < 0.001). When B-type natriuretic peptide was evaluated, in terms of capacity to predict acute kidney injury, the area under the curve was 0.702 (95% CI, 0.642-0.762).. In patients hospitalized with acute coronary syndromes, B-type natriuretic peptide levels measured at admission are associated with acute kidney injury as well as its severity.

Topics: Acute Coronary Syndrome; Acute Kidney Injury; Aged; Angioplasty, Balloon, Coronary; Biomarkers; Cause of Death; Cohort Studies; Coronary Care Units; Female; Hospital Mortality; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Prognosis; Prospective Studies; Renal Dialysis; Risk Assessment; ROC Curve; Survival Rate

Cocaine is a well known trigger of acute coronary syndromes. Over the last 10 years levamisole, a veterinary anthelminthic drug has been increasingly used as an adulterant of cocaine. Levamisole was used to treat pediatric nephritic syndrome and rheumatoid arthritis before being withdrawn from the market due to its significant toxicity, i.e. hematological complications and vasculitis. The major complications of levamisole-adultered cocaine reported up to now are hematological and dermatological. The case reported here is of a 25 year old man with a history of cocaine abuse who died at home after complaining of retrosternal pain. Postmortem CT-angiography, autopsy, and chemical and toxicological analyses were performed. An eroded coronary artery plaque was found at the proximal segment of the left anterior descending coronary artery. Two myocardial infarct scars were present in the left ventricle. Microscopic examination of the coronary artery revealed infiltration of eosinophils into the adventitia and intima. Toxicological examination confirmed the presence of cocaine and its metabolites in the peripheral blood, and of levamisole in the urine and pericardial fluid. Eosinophilic inflammatory coronary artery pathologies have been clinically linked to coronary dissection, hypersensitivity coronary syndrome and vasospastic allergic angina. The coronary pathology in the presented case could be a complication of levamisole-adultered cocaine use, in which an allergic or immune-mediated mechanism might play a role. The rise in cocaine addiction worldwide and the increase of levamisole adulterated cocaine highlights the importance of updating our knowledge of the effects of adultered cocaine abuse.

Topics: Acute Coronary Syndrome; Adult; Cocaine; Cocaine-Related Disorders; Coronary Vessels; Death, Sudden; Dopamine Agonists; Drug Contamination; Eosinophils; Humans; Levamisole; Male; Myocardium; Narcotics; Natriuretic Peptide, Brain; Peptide Fragments; Plaque, Atherosclerotic; Troponin I; Tryptases

Risk stratification in acute coronary syndrome without ST-segment elevation (NSTE-ACS) and troponin-negative remains a challenge. We evaluated the value of interleukin-6 (IL-6) and amino-terminal pro-B-type natriuretic peptide (NT-proBNP) in the prognosis assessment of low-moderate risk NSTE-ACS and troponin-negative, and whether these biomarkers could improve the predictive performance of the established thrombolysis in myocardial infarction (TIMI) risk score.. A total of 212 low-moderate risk patients with NSTE-ACS and troponin-negative were prospectively studied. Clinical follow up at 6 months was performed for adverse endpoints.. A total of 28 patients (13.5%) presented adverse clinical events. Those with adverse clinical events were associated with higher levels of IL-6 [8.58 (5.13-20.95) ng/l vs. 6.12 (4.16-9.14) ng/l, p = 0.043] and NT-proBNP [275.3 (108.6-548.2) ng/l vs. 126.8 (55.97-430.20) ng/l, p = 0.046]. In moderate risk group, we observed a higher event rate in patients with troponin-negative but elevated levels of IL-6 (p = 0.024). Only elevated IL-6 (> 12.40 ng/l) was an independent predictor of adverse outcomes [hazard ratios: 3.62, 95% confidence interval (CI) 1.69-7.75, p = 0.001]. The addition of IL-6 and history of ischaemic heart disease (IHD) to TIMI risk score significantly improved both the discrimination (integrated discrimination improvement, p = 0.003) and reclassification (Clinical Net reclassification improvement, p = 0.010) of the model for adverse events.. Interleukin-6 is an independent predictor of adverse events in low-moderate risk patients with NSTE-ACS and troponin-negative. Its use identifies a higher risk population in moderate-risk patients. This provides together with history of IHD a better discrimination and reclassification beyond that achieved with clinical risk variables from TIMI risk score in these patients.

Topics: Acute Coronary Syndrome; Angina Pectoris; Biomarkers; Female; Follow-Up Studies; Heart Failure; Humans; Interleukin-6; Male; Middle Aged; Myocardial Infarction; Myocardial Revascularization; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Prospective Studies; Recurrence; Risk Assessment; Troponin

Few studies have addressed the additional value of B-type natriuretic peptide (BNP) on risk stratification in non-ST-elevation acute coronary syndrome (NSTE-ACS). We aimed to evaluate whether BNP levels provide additional improvement on discrimination and reclassification of patients at risk of mortality during admission and follow up after a NSTE-ACS.. BNP levels were measured 24-96 hours post admission in 600 patients with a NSTE-ACS. The incremental predictive value of including BNP into the multivariate models with the highest predictive accuracy for mortality during admission (logistic regression) and follow up (Cox regression) and over the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk scores was assessed using calibration, discrimination (area under the ROC curve (AUC) and Harrell's C statistic), and reclassification measures (net reclassification improvement (NRI) and index discrimination improvement (IDI)).. A total of 19 (3.2%) patients died during admission and 29 (4.1%) during follow up (median 13.4 months). BNP was independently associated with mortality during admission (OR 3.56, 95% CI 1.75-7.23) and improved discrimination (AUC 0.95 vs. 0.92, p=0.01) and reclassification (NRI 72% and IDI 8%, p<0.05 for both). Similarly, BNP was an independent predictor of mortality during follow up (HR 2.46, 95% CI 1.94-3.12) and provided additional discriminative value (Harrell's C 0.86 vs. 0.84, p=0.04). Similarly, BNP demonstrated additional value above the TIMI and GRACE scores.. Determination of BNP 24-96 hours after a NSTE-ACS improved discrimination of patients at risk for mortality during admission and follow up.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Female; Hospital Mortality; Hospitalization; Humans; Male; Natriuretic Peptide, Brain; Prognosis; Prospective Studies; Risk Assessment; ROC Curve

Serum cystatin C (Cys-C), a good marker of renal function, predicts prognosis in non-ST-elevation acute coronary syndromes (NSTE-ACS). However, no data are available on the time course of Cys-C values after discharge. In this study, Cys-C was measured during admission (ACS sample) and 6 weeks after discharge, and was correlated with troponin (c-TNT), high-sensitivity C-reactive protein (hsCRP), interleukin 6 (IL-6) and the N-terminal portion of the pro-brain natriuretic peptide (proBNP) peptide (NT-proBNP) in a highly selected homogeneous group of NSTE-ACS patients.. In this prospective, multicentre study, patients with a first NSTE-ACS, single-vessel disease and successful percutaneous coronary interventions (PCIs) had their sera collected, aliquoted and stored at the enrolling site and then shipped for analysis to the clinical chemistry core laboratory.. Cys-C values slightly, but significantly, increased from the ACS samples to the 6-week samples. In contrast, hsCRP, NT-proBNP and IL-6 values significantly decreased from the ACS to the 6-week sample. Patients with elevated c-TNT levels had higher hsCRP, NT-proBNP and IL-6 values than patients with normal c-TNT levels in the ACS sample, whereas Cys-C levels were similar in patients with and without elevated c-TNT. Cys-C was highly correlated with estimated glomerular filtration rate in both the ACS and 6-week samples.. In contrast to inflammatory and biochemical stress markers, Cys-C is not affected by the occurrence of myocardial necrosis or by acute left-ventricular impairment, being a reliable marker of renal function during NSTE-ACS.

Topics: Acute Coronary Syndrome; Biomarkers; C-Reactive Protein; Cystatin C; Female; Humans; Inflammation Mediators; Interleukin-6; Italy; Male; Middle Aged; Myocardial Infarction; Myocardium; Natriuretic Peptide, Brain; Necrosis; Patient Admission; Patient Discharge; Peptide Fragments; Percutaneous Coronary Intervention; Prospective Studies; Risk Factors; Time Factors; Treatment Outcome; Troponin; Ventricular Function, Left

We sought to assess whether high-sensitivity C-reactive protein (hs-CRP) and pro-B-type natriuretic peptide (NT-proBNP) improve risk prediction when added to an established predictive tool and develop a point-based risk score.. Four hundred eleven vascular surgery patients were enrolled. The primary outcome was a composite of death, acute coronary syndromes, pulmonary edema within 30 days of surgery, and postoperative troponin-I elevation. The risk score was developed from a logistic regression model by using an integer-based scoring system.. The rate of the primary outcome was 18%. Adding both hs-CRP and NT-proBNP to the Revised Cardiac Risk Index led to an increase in C statistic from 0.670 to 0.774. The net reclassification improvement was 0.210 (P = 0.004) and the integrated discrimination improvement was 0.112 (P = 0.0001). In the multivariable regression analysis used to develop the risk score, insulin therapy for diabetes (odds ratio [OR]: 2.8; P = 0.003), open surgery (OR: 1.95; P = 0.027), fibrinogen >377 mg/dL (OR: 2.83; P = 0.001), hs-CRP >3.2 mg/L (OR: 3.85; P < 0.0001), and NT-proBNP >221 ng/L (OR: 4.05; P < 0.0001) were associated with the primary outcome. There was no statistical evidence of overfit. The C index was 0.82 and the Hosmer-Lemeshow statistic was 1.61 (P = 0.0447). The observed and predicted rates of the primary outcome across quartiles of risk score were highly correlated.. Hs-CRP and NT-proBNP substantially improve risk prediction when added to an established predictive tool. The biochemical marker-based risk score may be useful for accurately risk-stratifying vascular surgery patients; nonetheless, further validation studies on external datasets are needed before it can be used in clinical practice.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; C-Reactive Protein; Chi-Square Distribution; Decision Support Techniques; Female; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Odds Ratio; Peptide Fragments; Predictive Value of Tests; Prospective Studies; Pulmonary Edema; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Troponin I; Vascular Surgical Procedures

Topics: Acute Coronary Syndrome; Acute Kidney Injury; Cause of Death; Female; Humans; Male; Natriuretic Peptide, Brain

Biomarkers have emerged as interesting predictors of risk in patients with acute coronary syndromes (ACS). The aim of this study was to determine the utility of the combined measurement of cystatin C (CysC), C-reactive protein (CRP), N-terminal pro-brain natriuretic peptide (NT-proBNP) and red blood cell distribution width (RDW) in the risk stratification of patients with ACS.. In this prospective study including 682 patients consecutively admitted to a coronary care unit for ACS, baseline measurements of CysC, CRP, NT-proBNP and RDW were performed. Patients were categorized on the basis of the number of elevated biomarkers at presentation. The primary outcome was 6-month mortality.. The number of biomarkers elevated on admission (study score) was an independent predictor of 6-month mortality; patients with four biomarkers elevated on admission had a significantly higher risk of 6-month mortality compared with patients with none or one. In addition, in patients with high risk defined by the GRACE score, our multimarker score was able to further categorize their risk of 6-month mortality.. A multimarker approach using CysC, NT-proBNP, CRP and RDW was an independent predictor of 6-month mortality and added prognostic information to the GRACE risk score in patients with ACS and high risk defined by GRACE, with increasing mortality in patients with a higher number of elevated biomarkers on admission.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; C-Reactive Protein; Cystatin C; Erythrocyte Indices; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prospective Studies; Risk; Time Factors

Topics: Acute Coronary Syndrome; C-Reactive Protein; Cystatin C; Erythrocyte Indices; Female; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments

More recently, evidence showed that the novel anti-inflammatory cytokine interleukin- (IL-) 37 was expressed in the foam-like cells of atherosclerotic coronary and carotid artery plaques, suggesting that IL-37 is involved in atherosclerosis-related diseases. However, the plasma levels of IL-37 in patients with acute coronary syndrome (ACS, including unstable angina pectoris and acute myocardial infarction) have yet to be investigated.. Plasma IL-37, IL-18, and IL-18BP levels were measured in 50 patients with stable angina pectoris (SAP), 75 patients with unstable angina pectoris (UAP), 67 patients with acute myocardial infarction (AMI), and 65 control patients.. The plasma IL-37, IL-18, and IL-18BP levels were significantly increased in ACS patients compared to SAP and control patients. A correlation analysis showed that the plasma biomarker levels were positively correlated with each other and with the levels of C-reactive protein (CRP), N-terminal probrain natriuretic peptide (NT-proBNP), and left ventricular end-diastolic dimension (LVEDD) but negatively correlated with left ventricular ejection fraction (LVEF). Furthermore, the plasma IL-37, IL-18, and IL-18BP had no correlation with the severity of the coronary artery stenosis.. The results indicate that the plasma IL-37 levels are associated with the onset of ACS.

Topics: Acute Coronary Syndrome; Acute Disease; Aged; Angina Pectoris; C-Reactive Protein; Coronary Angiography; Echocardiography, Doppler; Enzyme-Linked Immunosorbent Assay; Female; Humans; Intercellular Signaling Peptides and Proteins; Interleukin-1; Interleukin-18; Leukocytes, Mononuclear; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Ventricular Function, Left

Increasing attention is being paid towards reducing short-term heart failure readmissions in recent years. Biomarkers such as galectin-3 are likely to play pivotal roles in future heart failure management strategies as they can provide objective information on various pathophysiologic processes involved in heart failure. Galectin-3 is a biomarker of inflammation and fibrosis, which is strongly associated with adverse remodeling of the myocardium and subsequent left ventricular dysfunction. Clinically, elevated galectin-3 levels are associated with increased risk for short- and long-term risk for mortality and heart failure readmission. Galectin-3 can provide incremental predictive value for adverse events over natriuretic peptides. Although significant work is still required to further define the role of galectin-3, it has the potential to become an important part of future heart failure management algorithms by helping to provide an individualized risk profile, which can be used to optimize resource allocation and improve treatment outcomes.

Topics: Acute Coronary Syndrome; Biomarkers; Blood Proteins; Fibrosis; Galectin 3; Galectins; Heart Failure; Humans; Inflammation; Natriuretic Peptide, Brain; Patient Readmission; Peptide Fragments; Prognosis; Risk Assessment; Ventricular Remodeling

Topics: Acute Coronary Syndrome; Aged; Aged, 80 and over; Biomarkers; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Takotsubo Cardiomyopathy; Troponin I

Contrast-induced nephropathy (CIN) is associated with significantly increased morbidity and mortality after percutaneous coronary intervention (PCI). Patients with acute coronary syndrome (ACS) are at higher risk for CIN. N-terminal pro-brain natriuretic peptide (NT-proBNP) is closely linked to the prognosis as a strong predictor of both short- and long-term mortality in patients with ACS.. We hypothesized that NT-proBNP levels on admission can predict the development of CIN after PCI for ACS.. A total of 436 patients (age 62.27 ± 13.01 years; 64.2% male) with ACS undergoing PCI enrolled in this study. Admission NT-proBNP levels were measured before PCI. Serum creatinine values were measured before and within 72 hours after the administration of contrast agents. Patients were divided into 2 groups: CIN group and no-CIN group. CIN was defined as an increase in serum creatinine level of ≥0.5 mg/dL or ≥25% above baseline within 72 hours after contrast administration.. CIN developed in 63 patients (14.4%). Baseline NT-proBNP levels were significantly higher in patients who developed CIN compared to those who did not develop CIN (median 774 pg/mL, interquartile range 177.4-2184 vs median 5159 pg/mL, interquartile range 2282-9677, respectively; P < 0.001). Multivariate analysis found that NT-proBNP (odds ratio [OR]: 3.448, 95% confidence interval [CI]: 1.394-8.474, P = 0.007) and baseline creatinine (OR: 6.052, 95% CI: 1.860-19.686, P = 0.003) were independent predictors of CIN.. Admission NT-proBNP level is an independent predictor of the development of CIN after PCI in ACS.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Contrast Media; Creatinine; Female; Humans; Kidney Diseases; Logistic Models; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Odds Ratio; Patient Admission; Peptide Fragments; Percutaneous Coronary Intervention; Risk Factors; Time Factors; Treatment Outcome; Up-Regulation

Topics: Acute Coronary Syndrome; Electrocardiography; Female; Humans; Natriuretic Peptide, Brain; Takotsubo Cardiomyopathy

Mannose-binding lectin (MBL) is a key component of innate immunity that starts one of the ways of complement activation. Factors of neutrophil activation are cell factors of innate and acquired immunity.. to study MBL levels and factors of neutrophil activation in patients with acute coronary syndrome (ACS).. A total of 45 patients with ST elevation (STE) ACS and non ST-elevation (NSTE) ACS were enrolled in the study, 15 persons were age-matched controls. RESULTS. Compared with control group MBL level was higher in patients with ACS (52.7 vs 127.2 hg/ml, respectively, p = 0.07), and significantly higher in patients with NSTE ACS (52.7 vs. 164.7 hg/ml, p = 0.03). There was no difference between MBL levels in STE ACS and NSTE ACS patients. Patients with inferior myocardial infarction (MI) had significantly higher MBL level than those with anterior MI (182.8 -92.7 hg/ml, p = 0.02). Patients with concomitant diabetes had statistically higher MBL level than patients without diabetes (225 vs 100 hg/ml, OR 2.25, p = 0.03). MBL level was lower in patients with low (<40%) ejection fraction - 92.7 vs 148.9 hg/ml in patients with EF > or = 40% (p = 0.19). No difference of neutrophil activation factors between ACS patients and controls was found (phagocytic activity of neutrophils 74.5 vs 74.3%, phagocytic number 3.34 vs 4.36, phagocytic reserve 88 vs 85.5 in ACS and control group, respectively).. Elevated innate immunity factor (MBL) level was associated with ACS, especially in patients with diabetes mellitus. No association between cell immunity factors with ACS was found.

Topics: Acute Coronary Syndrome; Adult; Aged; Biomarkers; Female; Humans; Leukocytes; Male; Mannose-Binding Lectin; Middle Aged; Natriuretic Peptide, Brain; Neutrophils; Phagocytosis

Identification of patients who are at high risk of adverse cardiovascular events after an acute coronary syndrome (ACS) remains a major challenge in clinical cardiology. We hypothesized that quantifying variability in electrocardiogram (ECG) morphology may improve risk stratification post-ACS.. We developed a new metric to quantify beat-to-beat morphologic changes in the ECG: morphologic variability in beat space (MVB), and compared our metric to published ECG metrics (heart rate variability [HRV], deceleration capacity [DC], T-wave alternans, heart rate turbulence, and severe autonomic failure). We tested the ability of these metrics to identify patients at high risk of cardiovascular death (CVD) using 1082 patients (1-year CVD rate, 4.5%) from the MERLIN-TIMI 36 (Metabolic Efficiency with Ranolazine for Less Ischemia in Non-ST-Elevation Acute Coronary Syndrome-Thrombolysis in Myocardial Infarction 36) clinical trial. DC, HRV/low frequency-high frequency, and MVB were all associated with CVD (hazard ratios [HRs] from 2.1 to 2.3 [P<0.05 for all] after adjusting for the TIMI risk score [TRS], left ventricular ejection fraction [LVEF], and B-type natriuretic peptide [BNP]). In a cohort with low-to-moderate TRS (N=864; 1-year CVD rate, 2.7%), only MVB was significantly associated with CVD (HR, 3.0; P=0.01, after adjusting for LVEF and BNP).. ECG morphological variability in beat space contains prognostic information complementary to the clinical variables, LVEF and BNP, in patients with low-to-moderate TRS. ECG metrics could help to risk stratify patients who might not otherwise be considered at high risk of CVD post-ACS.

Topics: Acute Coronary Syndrome; Aged; Cardiovascular Diseases; Cohort Studies; Electrocardiography; Female; Heart Rate; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Prognosis; Proportional Hazards Models; Risk Assessment; Risk Factors; Stroke Volume

The aim of this study was to investigate the N-terminal brain natriuretic peptide precursor (NT-proBNP) levels in the peripheral blood of patients with acute coronary syndrome (ACS) and to provide the basis for its application in the early diagnosis of ACS. A total of 440 patients admitted to the hospital for examination and treatment were enrolled, including 330 patients with ACS and 110 cases in the control group. Routine blood examination and determination of NT-proBNP in all subjects were conducted immediately at the time of admission to analyze the difference in plasma NT-proBNP between the two groups. The plasma NT-proBNP levels in ACS were significantly higher (P < 0.01) and were associated with the severity of coronary lesions. The present study indicated that the plasma NT-proBNP level in ACS patients is significantly increased and has a potential value in the early diagnosis of ACS.

Topics: Acute Coronary Syndrome; Aged; Case-Control Studies; Electrocardiography; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Risk Factors; Severity of Illness Index

Patients may develop kidney failure because of the contrast agent given during coronary angiography. Renal dysfunction and heart failure were previously shown to be associated with the development of contrast nephropathy. In our study, we aimed to investigate whether there is a relationship between subclinical renal (indicated by microalbuminuria) and/or cardiac (indicated by the height of the BNP) dysfunction between the development of contrast-induced nephropathy on patients undergoing angiography due to acute coronary syndrome.. This is an observational prospective cohort study. A total of 170 patients hospitalized with a diagnosis of acute coronary syndrome in the coronary care unit were included in this study. Blood samples were collected from 145 patients without microalbuminuria and 25 patients with microalbuminuria to determine their BNP levels before coronary angiography. The patients' urea and creatinine levels were examined before and 72 h after coronary angiography. Statistical analysis was performed using Kolmogorov-Smirnov test, Mann-Whitney U test, independent samples t-test and the chi-square test.. The study subjects included 82 females and 88 males (average age, 64.4±14.5 years). The BNP levels and height distribution of the 145 patients without microalbuminuria were compared between those with and without contrast agent-induced nephropathy, but no significant difference was found (205.6±280.6, 198.0±310.0, p=0.817). Similarly, no relationship between the microalbumin level and contrast agent-induced nephropathy was found in 25 patients.. A relationship between BNP, microalbuminuria, and contrast agent-induced nephropathy was not found in patients hospitalized in a coronary care unit with a diagnosis of acute coronary syndrome who were scheduled for coronary angiography. Additional multicenter studies with larger patient groups should be conducted to obtain more data.

Topics: Acute Coronary Syndrome; Albuminuria; Cohort Studies; Contrast Media; Coronary Angiography; Female; Humans; Kidney Diseases; Male; Middle Aged; Natriuretic Peptide, Brain; Prospective Studies

Inflammation is a key factor in the long-term outcome of acute coronary syndromes (ACS). The aim of the present study was to evaluate inflammatory markers in patients with ACS as predictors for major adverse cardiovascular events (MACE) and hard events.. This study included 1548 patients with ACS. C-reactive protein (CRP), white blood count (WBC), and their subtypes were analyzed during hospitalization. Receiver operator characteristic (ROC) and Kaplan-Meier survival curves were used to assess the predictive value and hard events (nonfatal myocardial infarction and cardiac death) and MACE (hard events, hospitalization for cardiac causes, late revascularization and stroke) were obtained during 30 days.. ROC analysis of CRP and WBC to predict adverse events revealed cut-offs of 47.5 ng/l and 16.6 × 10/μl for MACE and 93.5 ng/l and 16.6 × 10/μl for hard events. The cumulative adverse event rates were significantly higher in patients with increased CRP (≥47.5 ng/l; 17 versus 4%, P < 0.001) and WBC (≥16.6 × 10/μl; 21 versus 5%, P < 0.001) for MACE and with elevated CRP (≥93.5 ng/l; 16 versus 2%, P < 0.001) and WBC (≥16.6 × 10/μl; 18 versus 2%, P < 0.001) for hard events, demonstrating highest event rates with elevation of both inflammatory markers: (28 versus 5%, P < 0.001) for MACE and (26 versus 2%, P < 0.001) for hard events. Analysis of CRP and WBC further revealed a substantial negative correlation with left ventricular function (P < 0.001). Moreover, markers of myocardial damage were significantly elevated in patients with abnormal CRP or WBC (P < 0.001).. Inflammatory markers such as CRP and WBC alone and, particularly, in combination are strong and independent predictors of outcome in patients with ACS.

Topics: Acute Coronary Syndrome; Biomarkers; C-Reactive Protein; Coronary Angiography; Creatine Kinase; Female; Flow Cytometry; Humans; Inflammation; Leukocyte Count; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Retrospective Studies; Survival Rate; Troponin T

Sensitive troponin assays have substantially improved early diagnosis of myocardial infarction. However, the role of sensitive cardiac troponin (cTn) assays in prediction of significant coronary lesions and long-term prognosis in non-ST-elevation acute coronary syndrome (NSTE-ACS) remains unresolved.. This prospective study includes 458 consecutive patients with NSTE-ACS admitted for coronary angiography. Serum levels of 4 commercial available sensitive troponin assays were analyzed (Roche high-sensitive cTnT [hs-cTnT; Roche Diagnostics, Basel, Switzerland], Siemens cTnI Ultra [Siemens, Munich, Germany], Abbott-Architect cTnI [Abbott, Abbott Park, IL], Access Accu-cTnI [Beckman Coulter, Nyon, Switzerland]), as well as a standard assay (Roche cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), before coronary angiography.. The relationship between the analyzed biomarkers and significant coronary lesions on coronary angiography, as quantified by area under the receiver operating characteristic curve, was significantly higher with Roche hs-cTnT, Siemens cTnI Ultra, and Access Accu-cTnI as compared with standard troponin T assay (P < .001 for all comparisons). This difference was mainly caused by increased sensitivity below the 99th percentile. Also, NT-proBNP was associated with the presence of significant coronary lesions. Cardiac troponin values were correlated with cardiac death (primary end point) during 1373 (1257-1478) days of follow-up. In both univariate and multivariate Cox regression analyses, NT-proBNP was superior to both hs-cTnT and cTnI in prediction of cardiovascular mortality. Troponin values with all assays were correlated with the need for repeated revascularization (secondary end point) during follow-up.. Sensitive cTn assays are superior to standard cTnT assay in prediction of significant coronary lesions in patients with NSTE-ACS. However, this improvement is primary caused by increased sensitivity below the 99th percentile. N-terminal pro-B-type natriuretic peptide is superior to cTns in prediction of long-term mortality.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Coronary Angiography; Early Diagnosis; Female; Follow-Up Studies; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Prospective Studies; Protein Precursors; ROC Curve; Time Factors; Troponin I; Troponin T

Topics: Acute Coronary Syndrome; Biomarkers; Humans; Myocardium; Natriuretic Peptide, Brain; Predictive Value of Tests; Severity of Illness Index

N terminal-proB-type natriuretic peptide (NT-proBNP) is synthesised and secreted from the ventricular myocardium. This marker is known to be elevated in patients with acute coronary syndromes (ACS). We evaluated NT-proBNP asa significant diagnostic marker and an important independent predictor of short-term mortality (one month) in patients with ACS.. NT-proBNP and cardiac troponin I (cTI) were assessed in 134 consecutive patients (median age 66 years, 73% male)hospitalised for ACS in a cardiological university department. The patients were classified into ST-elevation ACS (STE-ACS, n = 74) and non-ST-elevation ACS (NSTE-ACS, n = 60) groups based on the ECG findings on admission. Patients with Killip class ≥ II were excluded.. The serum level of NT-proBNP on admission was significantly higher (p < 0.0005), while there was no difference in cTI serum level in the NSTE-ACS patients compared to STE-ACS patients. There was a significant positive correlation between NT-proBNP and cTI in the NSTE-ACS (r = 0.338, p = 0.008) and STE-ACS (r = 0.441, p < 0.0005) patients. There was a significant difference in NT-proBNP (p < 0.0005) and cTI (p < 0.0005) serum level between ACS patients who died within 30 days or who survived after one month. The increased NT-proBNP level is the strongest predictor of mortality in ACS patients, also NT-proBNP cut-point level of 1,490 pg/mL is a significant independent predictor of mortality.. We demonstrated the differences and the correlation in the secretion of NT-proBNP and cTI in patients with STE-ACS vs. NSTE-ACS. Our results provide evidence that NT-proBNP is a significant diagnostic marker and an important independent predictor of short-term mortality in patients with ACS.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Coronary Angiography; Female; Humans; Logistic Models; Male; Myocardial Ischemia; Myocardium; Natriuretic Peptide, Brain; Necrosis; Peptide Fragments; Percutaneous Coronary Intervention; Prognosis; Prospective Studies; ROC Curve; Stents; Survival Rate; Troponin I

The level of serum brain natriuretic peptide (BNP) was measured in 236 patients with acute coronary syndrome. Some of them presented with mitochondrial dysfunction. None showed diagnostically significant BNP levels within 12 hours after admittance, but patients with unstable angina and BNP level below 80 pg/ml had the lowest risk of serious cardiovascular diseases. Marked mitochondrial dysfunction was associated with maximum BNP levels 12 hr and 14 days after hospitalization and mild dysfunction with minimal BNP concentration.

Topics: Acute Coronary Syndrome; Aged; Angina, Unstable; Female; Humans; Male; Middle Aged; Mitochondria; Natriuretic Peptide, Brain; Risk; Severity of Illness Index; Time Factors

Guidelines recommend the use of validated risk scores and a high-sensitivity cardiac troponin assay for risk assessment in non-ST-elevation acute coronary syndrome (NSTE-ACS). The incremental prognostic value of biomarkers in this context is unknown.. We calculated the Global Registry of Acute Coronary Events (GRACE) score and measured the circulating concentrations of high-sensitivity cardiac troponin T (hs-cTnT) and 8 selected cardiac biomarkers on admission in 1146 patients with NSTE-ACS. We used an hs-cTnT threshold at the 99th percentile of a reference population to define increased cardiac marker in the score. The magnitude of the increase in model performance when individual biomarkers were added to GRACE was assessed by the change (Δ) in the area under the receiver-operating characteristic curve (AUC), integrated discrimination improvement (IDI), and category-free net reclassification improvement [NRI(>0)].. Seventy-eight patients reached the combined end point of 6-month all-cause mortality or nonfatal myocardial infarction. The GRACE score alone had an AUC of 0.749. All biomarkers were associated with the risk of the combined end point and offered statistically significant improvement in model performance when added to GRACE (likelihood ratio test P ≤ 0.015). Growth differentiation factor 15 [ΔAUC 0.039, IDI 0.049, NRI(>0) 0.554] and N-terminal pro-B-type natriuretic peptide [ΔAUC 0.024, IDI 0.027, NRI(>0) 0.438] emerged as the 2 most promising biomarkers. Improvements in model performance upon addition of a second biomarker were small in magnitude.. Biomarkers can add prognostic information to the GRACE score even in the current era of high-sensitivity cardiac troponin assays. The incremental information offered by individual biomarkers varies considerably, however.

Topics: Acute Coronary Syndrome; Biomarkers; Growth Differentiation Factor 15; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Retrospective Studies; Risk Assessment; Sensitivity and Specificity; Troponin T

High-sensitivity troponin assays have improved the diagnosis of acute coronary syndrome in patients presenting with chest pain and normal troponin levels as measured by conventional assays. Our aim was to investigate whether N-terminal pro-brain natriuretic peptide provides additional information to troponin determination in these patients.. A total of 398 patients, included in the PITAGORAS study, presenting to the emergency department with chest pain and normal troponin levels as measured by conventional assay in 2 serial samples (on arrival and 6 h to 8h later) were studied. The samples were also analyzed in a central laboratory for high-sensitivity troponin T (both samples) and for N-terminal pro-brain natriuretic peptide (second sample). The endpoints were diagnosis of acute coronary syndrome and the composite endpoint of in-hospital revascularization or a 30-day cardiac event.. Acute coronary syndrome was adjudicated to 79 patients (20%) and the composite endpoint to 59 (15%). When the N-terminal pro-brain natriuretic peptide quartile increased, the diagnosis of acute coronary syndrome also increased (12%, 16%, 23% and 29%; P=.01), as did the risk of the composite endpoint (6%, 13%, 16% and 24%; P=.004). N-terminal pro-brain natriuretic peptide elevation (>125ng/L) was associated with both endpoints (relative risk= 2.0; 95% confidence interval, 1.2-3.3; P=.02; relative risk=2.4; 95% confidence interval, 1.4-4.2; P=.004). However, in the multivariable models adjusted by clinical and electrocardiographic data, a predictive value was found for high-sensitivity T troponin but not for N-terminal pro-brain natriuretic peptide.. In low-risk patients with chest pain of uncertain etiology evaluated using high-sensitivity T troponin, N-terminal pro-brain natriuretic peptide does not contribute additional predictive value to diagnosis or the prediction of short-term outcomes.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Chest Pain; Endpoint Determination; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Prospective Studies; Troponin

Recent experimental evidence suggests that the Rho/Rho-kinase (ROCK) system may play an important role in the pathogenesis of acute coronary syndrome (ACS) but there are little clinical data. This study examined if ROCK activity is increased in patients with acute coronary syndrome and if ROCK activity predicts long-term cardiovascular event.. Blood samples were collected from 188 patients within 12h after admission for ACS (53% men; aged 70 ± 13) and from 61 control subject. The main outcome measures were all cause mortality, readmission with ACS or congestive heart failure (CHF) from presentation within around 2 years (mean:14.4 ± 7.2 months; range: 0.5 to 26 months).. ROCK activity increased in ST elevation myocardial infarction (STEMI, n=90) (3.33 ± 0.93), non-STEMI (NSTEMI, n=68) (3.37 ± 1.04) and unstable angina (UA, n=30) (2.53 ± 0.59) groups when compared with disease controls (n=31) (2.06 ± 0.38, all p<0.001) and healthy controls (n=30) (1.54 ± 0.43, all p<0.001). There were 24 deaths, 34 readmissions with ACS and 15 admissions with CHF within 2 years. Patients with a high N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high ROCK activity on admission had a five-fold risk of a cardiovascular event (RR: 5.156; 95% CI: 2.180-12.191) when compared to those with low NT-proBNP and low ROCK activity.. ROCK activity was increased in patients with ACS, particularly in those with myocardial infarction. The combined usage of both ROCK activity and NT-proBNP might identify a subset of ACS patients at particularly high risk.

Topics: Acute Coronary Syndrome; Aged; Aged, 80 and over; Biomarkers; Enzyme Activation; Female; Follow-Up Studies; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; rho-Associated Kinases; Risk Factors; Treatment Outcome

Intermedin (IMD) is a newly discovered peptide with increased levels in plasma and cardiac tissue in mice with ischemia/reperfusion. Continuous administration of low dose IMD markedly elevated the mRNA abundance of myocardial BNP in rats. Plasma BNP levels may reflect the severity of degree of coronary stenosis in patients with acute coronary syndrome (ACS). However, the role of circulating IMD in coronary heart disease remains unclear. We aimed to examine the plasma content of IMD and brain natriuretic peptide (BNP) and its clinical significance in patients with ACS. We collected plasma samples from 41 patients with ACS and 31 controls and measured IMD and BNP levels by radioimmunoassay. The severity of coronary artery stenosis for patients with ACS was measured by coronary angiography. Plasma IMD and BNP levels were markedly higher in ACS patients than that in controls (P<0.05). The increased plasma IMD and BNP were positively correlated with degree of coronary stenosis in ACS patients (r=0.263 and r=0.238, respectively, both P<0.05). In addition, plasma levels of IMD were positively correlated with BNP levels.

Topics: Acute Coronary Syndrome; Adult; Aged; Case-Control Studies; Coronary Angiography; Coronary Stenosis; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Hormones

B-type natriuretic peptide (BNP) has been employed as a risk marker in patients with coronary artery disease (CAD) with ST elevation and non-ST elevation. It is not yet established if early BNP measurements provide additional information to troponin and electrocardiographic analysis in patients without ventricular enlargement and systolic dysfunction.. This study compared BNP levels in patients with stable angina (SA) and acute coronary syndromes with non-ST elevation in relation to angiographic lesions (NSTEMI-ACS). Moreover, the diagnostic utility of BNP was determined using the receiver operating characteristic curve.. 280 patients with CAD without ST elevation and preserved systolic function were studied. BNP samples were measured in all recruited patients within 24 hours of hospitalization.. BNP values increased progressively with the severity of diagnosis: SA (n = 85; 50.4 ± 50 pg/ml) NSTEMI-ACS (n = 195; 283 ± 269 pg/ml; p < 0.0001). The analysis of BNP in relation to the number of involved vessels demonstrated significantly increased levels in patients with multivessel disease compared to patients with 1- or 2-vessel disease (p < 0.001 and p < 0.003). Values of BNP >80 pg/ml were shown to be able to predict CAD severity and coronary vessel involvement (AUC = 0.80; p = 0.0001) with a sensitivity of 78% and a specificity of 72%. In multivariate analysis, BNP levels >80 pg/ml, CAD history, and ST deviation >2 mm were confirmed as independent predictors of CAD severity.. Circulating BNP levels appear elevated in NSTEMI-ACS, without left ventricular systolic dysfunction. A BNP cut-off value of 80 pg/ml is a good predictor of CAD extension.

Topics: Acute Coronary Syndrome; Aged; Angina, Stable; Biomarkers; Coronary Angiography; Coronary Disease; Female; Humans; Italy; Logistic Models; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Predictive Value of Tests; Retrospective Studies; Risk Assessment; Risk Factors; ROC Curve; Sensitivity and Specificity; Severity of Illness Index; Systole; Up-Regulation; Ventricular Function, Left

The present study was designed to build and validate a composite score based on the Global Registry of Acute Coronary Events (GRACE) score and B-type natriuretic peptide (BNP) concentrations to predict outcome in patients with acute coronary syndromes (ACS).. The GRACE risk score and BNP concentrations were obtained in a retrospective and a prospective cohort. A composite score including the GRACE score and BNP concentrations was first developed in a retrospective cohort of 248 patients with ACS and then validated in a prospective cohort of 575 patients. The primary outcome was 6-month death or myocardial infarction.. End points were reached in 34 patients in the retrospective cohort and in 68 patients in the prospective cohort. Both higher BNP concentration and GRACE score were independently associated with outcome in the retrospective cohort (p=0.003 and p<0.0001). The composite score could be obtained as follows: GRACE+BNP/60. The use of the composite score increased the accuracy of the GRACE score, with an increase in the C statistic from 0.810 (0.727 to 0.892) to 0.822 (0.745 to 0.902) in the retrospective cohort and from 0.724 (0.657 to 0.791) to 0.750 (0.686 to 0.813) in the prospective cohort. Finally, 7% of patients in the prospective study population were reclassified from low to high risk or from high to low risk using this composite score.. Plasma BNP levels refine the accuracy of the GRACE score. A comprehensive risk score, which includes BNP concentration and the GRACE risk score, might improve ACS risk stratification in clinical practice.

Topics: Acute Coronary Syndrome; Biomarkers; Disease-Free Survival; Humans; Multivariate Analysis; Myocardial Infarction; Natriuretic Peptide, Brain; Predictive Value of Tests; Prospective Studies; Reproducibility of Results; Retrospective Studies

The KCNE family is a group of small transmembrane channel proteins involved in potassium ion (K(+)) conductance. The X-linked KCNE5 gene encodes a regulator of the K(+) current mediated by the potassium channel KCNQ1. Polymorphisms in KCNE5 have been associated with altered cardiac electrophysiological properties in human studies. We investigated associations of the common rs697829 polymorphism from KCNE5 with baseline characteristics, baseline electrocardiographic (ECG) measurements, and patient survival in a cohort of post-acute coronary syndromes (ACS) patients (the Coronary Disease Cohort Study cohort).. DNA samples (n = 1,740) were genotyped for rs697829 using a TaqMan assay. Baseline ECG data revealed corrected QT (QTc) interval was associated with rs697829 in male, but not female, patients, being extended in the G genotype group (A 416 ± 1.71; G 431 ± 4.25 ms, P = 0.002). Covariate-adjusted survival was poorest in G genotype patients in Cox proportional hazard modeling of mortality data of males (P(overall) = 0.020). Male patients with G genotype had a hazard ratio of 1.44 (1.11-2.33) for death when compared to the A genotype male patients (P = 0.048) after adjustment for age, baseline log-transformed N-terminal pro-B-type natriuretic peptide (NTproBNP), β-blocker and insulin treatment, QTc interval, history of myocardial infarction, and physical activity score.. This study suggests an association between rs697829, a common single nucleotide polymorphism (SNP) from KCNE5, and ECG measurements and survival in postacute ACS patients. Prolonged subclinical QT interval may be a marker of adverse outcome in this group of patients. 

Topics: 3' Untranslated Regions; Acute Coronary Syndrome; Aged; Analysis of Variance; Cohort Studies; Creatine Kinase; DNA; Echocardiography; Electrocardiography; Female; Genotype; Humans; Long QT Syndrome; Male; Middle Aged; Natriuretic Peptide, Brain; Neurotransmitter Agents; Peptide Fragments; Polymerase Chain Reaction; Polymorphism, Single Nucleotide; Potassium Channels, Voltage-Gated; Proportional Hazards Models; Sex Characteristics; Survival; Survival Analysis; Troponin T

Takotsubo cardiomyopathy (TC) usually is not recognized until heart catheterization reveals typical wall motion abnormalities in the absence of significant coronary artery disease. It was our aim to identify TC by its unique cardiac biomarker profile at an early stage and, preferably, with non-invasive procedures only.. Ratios of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and myoglobin, NT-proBNP and troponin T (TnT), NT-proBNP and creatinekinase-MB (CK-MB) were compared in patients with TC (n=39), patients with ST-elevation myocardial infarction (STEMI, n=48) and patients with non-ST-elevation myocardial infarction (NSTEMI, n=34). Biomarkers were recorded serially at admission and at the three consecutive days. Optimal cut-off values to distinguish TC from STEMI and NSTEMI were calculated with receiver operator characteristic (ROC) curves.. At admission a NT-proBNP (ng/l)/myoglobin (μg/l) ratio of 3.8, distinguished TC from STEMI (sensitivity: 89%, specificity: 90%), while a NT-proBNP (ng/l)/myoglobin (μg/l) ratio of 14 separated well between TC and NSTEMI (sensitivity: 65%, specificity: 90%). Best differentiation of TC and ACS was possible with the ratio of peak levels of NT-proBNP (ng/l)/TnT (μg/l). A cut-off value of NT-proBNP (ng/l)/TnT (μg/l) ratio of 2889, distinguished TC from STEMI (sensitivity: 91%, specificity: 95%), while a NT-proBNP (ng/l)/TnT (μg/l) ratio of 5000 separated well between TC and NSTEMI (sensitivity: 83%, specificity: 95%).. TC goes along with a singular cardiac biomarker profile, which might be useful to identify patients with TC among patients presenting with acute coronary syndromes (ACS).

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Myoglobin; Natriuretic Peptide, Brain; Peptide Fragments; Retrospective Studies; Takotsubo Cardiomyopathy; Troponin T

Midregional proadrenomedullin (MR-proADM) is a newly identified prognostic marker in heart failure. We evaluated the prognostic impact of MR-proADM in a cohort of patients with symptomatic coronary artery disease according to their clinical presentation.. We measured baseline MR-proADM concentrations in 2240 individuals from the prospective AtheroGene study and evaluated the prognostic impact on future fatal and nonfatal cardiovascular events during a follow-up period of 3.6 (1.6) years.. The sample comprised 1355 individuals with stable angina pectoris (SAP) and 885 with acute coronary syndrome (ACS). A cardiovascular event occurred in 192 people. Individuals presenting with SAP had only slightly lower plasma MR-proADM concentrations than those with ACS (0.53 vs 0.55 nmol/L, P=0.006). MR-proADM showed a moderate association with age, serum N-terminal pro-B-type natriuretic peptide (NT-proBNP), glomerular filtration rate, serum C-reactive protein, hypertension, diabetes, and prevalent multivessel disease (all P<0.0005). Individuals suffering from a cardiovascular event had higher MR-proADM concentrations at baseline in both groups (SAP 0.63 vs 0.53 nmol/L and ACS 0.65 nmol/L vs 0.55 nmol/L, both P<0.0005). Cox regression analysis incorporating various variables of cardiovascular risk and NT-proBNP revealed a hazard ratio of 1.4 (95% CI 1.2-1.6; P<0.0005) per increment of MR-proADM by 1SD. In risk models for secondary prevention, MR-proADM provided information comparable to that of NT-proBNP.. MR-proADM is an independent predictor for future cardiovascular events in patients with symptomatic coronary artery disease, providing information comparable to NT-proBNP for secondary risk stratification.

Topics: Acute Coronary Syndrome; Adrenomedullin; Aged; Angina Pectoris; Biomarkers; Coronary Artery Disease; Female; Humans; Immunoassay; Kaplan-Meier Estimate; Luminescent Measurements; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Prospective Studies; Protein Precursors; Risk Assessment

We investigated the prognostic performance of ST2 with respect to cardiovascular death (CVD) and heart failure (HF) in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) in a large multinational trial.. Myocytes that are subjected to mechanical stress secrete ST2, a soluble interleukin-1 receptor family member that is associated with HF after STE-ACS.. We measured ST2 with a high-sensitivity assay in all available baseline samples (N=4426) in patients enrolled in the Metabolic Efficiency With Ranolazine for Less Ischemia in the Non-ST-Elevation Acute Coronary Syndrome Thrombolysis in Myocardial Infarction 36 (MERLIN-TIMI 36), a placebo-controlled trial of ranolazine in NSTE-ACS. All events, including cardiovascular death and new or worsening HF, were adjudicated by an independent events committee.. Patients with ST2 concentrations in the top quartile (>35 μg/L) were more likely to be older and male and have diabetes and renal dysfunction. ST2 was only weakly correlated with troponin and B-type natriuretic peptide. High ST2 was associated with increased risk for CVD/HF at 30 days (6.6% vs 1.6%, P<0.0001) and 1 year (12.2% vs 5.2%, P<0.0001). The risk associated with ST2 was significant after adjustment for clinical covariates and biomarkers (adjusted hazard ratio CVD/HF 1.90, 95% CI 1.15-3.13 at 30 days, P=0.012; 1.51, 95% CI 1.15-1.98 at 1 year, P=0.003), with a significant integrated discrimination improvement (P<0.0001). No significant interaction was found between ST2 and ranolazine (Pinteraction=0.15).. ST2 correlates weakly with biomarkers of acute injury and hemodynamic stress but is strongly associated with the risk of HF after NSTE-ACS. This biomarker and related pathway merit further investigation as potential therapeutic targets for patients with ACS at risk for cardiac remodeling.

Topics: Acetanilides; Acute Coronary Syndrome; Aged; Biomarkers; Cardiovascular Diseases; Electrocardiography; Female; Heart Failure; Hemodynamics; Humans; Inflammation; Interleukin-1 Receptor-Like 1 Protein; Male; Natriuretic Peptide, Brain; Piperazines; Prognosis; Randomized Controlled Trials as Topic; Ranolazine; Receptors, Cell Surface; Risk Assessment

Our aim was to investigate the associations between B-type natriuretic peptide (NT-proBNP), troponin T (TnT) and C-reactive protein (CRP) and changes in left ventricular function and size after acute coronary syndrome.. In 119 patients admitted for non-ST-elevation acute coronary syndrome, echocardiography and blood sampling were performed prior to coronary angiography. Echocardiography was repeated at follow-up after 8 ± 3 months. Left ventricular function was assessed by speckle tracking echocardiography. In 50 patients, infarct size was determined by magnetic resonance imaging. The associations between baseline levels of NT-proBNP, TnT and CRP and myocardial functional recovery, left ventricular intraventricular volumes and infarct size were determined by linear regression.. All three biomarkers were associated with myocardial dysfunction at baseline. However, high levels of NT-proBNP were associated with better myocardial recovery, as measured by global longitudinal strain, even after adjusting for other factors potentially influencing myocardial recovery.. Elevated levels of NT-proBNP at baseline are independently associated with improved myocardial performance 8 months after non-ST-elevation acute coronary syndrome.

Topics: Acute Coronary Syndrome; Biomarkers; C-Reactive Protein; Coronary Angiography; Female; Heart Ventricles; Humans; Linear Models; Magnetic Resonance Imaging; Male; Middle Aged; Multivariate Analysis; Myocardium; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Prospective Studies; Statistics as Topic; Treatment Outcome; Troponin T; Ultrasonography

Elevated ST2 predicts future heart failure and/or death in patients with pulmonary diseases, heart failure, acute dyspnea, and acute coronary syndromes. This study assesses both diagnostic and prognostic utility of ST2 in patients with chest pain.. From November 2007 to April 2010, 995 patients attending the Emergency Department with chest pain were prospectively recruited. Troponin I (TnI), B-type natriuretic peptide (BNP), creatine kinase-myocardial band (CKMB), myoglobin, and ST2 were measured at 0 and 2 hours. The diagnostic utility of ST2 for heart failure and prognostic utility for primary outcome of death and/or heart failure by 18 months was assessed. Elevated ST2 had sensitivity 73.5% (55.8%-86.4%) and specificity 79.6% (79.0%-80.1%) for acute heart failure (n = 34) [compared with BNP sensitivity 88.2% (73.6%-95.3%), specificity 66.2% (65.7%-66.4%)]. Elevated ST2 conveyed risk of 18-month primary outcome (n = 110), with an adjusted hazard ratio (HR) of 1.9 (1.2-3.2), compared with BNP HR 2.8 (1.4-5.7), myoglobin HR 1.9 (1.1-3.3), TnI HR 1.7 (1.0-2.7), and CKMB HR 0.9 (0.5-1.7). When ST2 and BNP were both elevated, risk was greater than if either marker was elevated in isolation (P < .001).. ST2 was more specific for acute heart failure than BNP. ST2 is independently predictive of future death and/or heart failure and has incremental utility in combination with BNP.

Topics: Acute Coronary Syndrome; Chest Pain; Creatine Kinase, MB Form; Emergency Service, Hospital; Female; Heart Failure; Humans; Interleukin-1 Receptor-Like 1 Protein; Kaplan-Meier Estimate; Male; Middle Aged; Myoglobin; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Prospective Studies; Receptors, Cell Surface; Receptors, Interleukin-1; Sensitivity and Specificity; Troponin I

B-type (brain) natriuretic peptide (BNP) is a cardiac hormone whose measurement can be helpful in a variety of clinical settings, but has been most extensively studied in patients with heart failure and acute coronary syndrome (ACS). The value of both BNP and its N-terminal fragment, NT-proBNP, as independent prognostic biomarkers in ACS is supported by data from a number of clinical trials. BNP/NT-proBNP levels can predict death and subsequent development of heart failure, but not recurrent ischemic events. BNP may also be helpful as an aid in establishing the diagnosis of ACS in patients presenting with chest pain. The role of BNP in determining treatment has not yet been defined, though patients with high levels may derive more benefit from invasive management and from treatment with ranolazine. The National Academy of Clinical Biochemists (NACB) guidelines state that measurement of BNP/NT-proBNP may be useful in prognosis for ACS patients, but do not yet recommend its routine use, naming a number of other issues that need to be resolved in the use of this marker. Age- and gender-related decision limits should be determined, and cutoff levels of BNP/NT-proBNP corresponding to low, intermediate, and high risk patients should be ascertained. Additional evidence regarding the impact of BNP/NT-proBNP levels on treatment strategy in ACS patients will be helpful in further defining the role of B-type natriuretic peptide testing in the acute coronary syndromes.

Topics: Acute Coronary Syndrome; Humans; Natriuretic Peptide, Brain

The prognostic value of BNP in acute coronary syndrome (ACS) has been repeatedly assessed, but not completely well established. Literature data for establishing the best time for assessing BNP, be it on hospital admission or after coronary intervention, are controversial.. To analyze BNP in non-ST segment elevation ACS (NSTE-ACS) in the long term, and to assess the association between BNP (pg/ml), death, coronary anatomy, and TIMI Risk Score.. Forty patients with NSTE-ACS and troponin>0.50 ng/ml had their BNP levels measured on admission and 96 hours after, and were followed up for four years. The difference between the two measures was assessed by use of Wilcoxon test (p<0.05). The ROC curve was used to evaluate 96-hour BNP accuracy as a death predictor, and logistic regression was used to assess a possible confounding factor among 96-hour BNP, age, and outcome.. There was an increase in the 96-hour BNP (148 on admission vs. 267 after 96 hours; p=0.04). Thirteen patients died. For the 300 pg/ml cutoff, 96-hour BNP was a death predictor (sensitivity, 92.30%; specificity, 77.80%; positive predictive value, 66.70%; negative predictive value, 95.50%). The area under the ROC curve was 0.92. A 7.4-time increase in the relative risk of death in four years was observed with a 96-hour BNP> 300 pg/ml (95% CI 1.90 a 29.30 p<0.01). An association between 96-hour BNP and TIMI Risk Score was observed (p<0.01). An association was observed between the increase in 96-hour BNP and multivessel disease (p=0.02).. In NSTE-ACS with positive troponin, 96-hour BNP can be a tool for risk stratification.

Topics: Acute Coronary Syndrome; Aged; Aged, 80 and over; Biomarkers; Coronary Vessels; Epidemiologic Methods; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Prognosis; Reference Values; Time Factors

Compared to troponin alone, a dual-marker strategy with natriuretic peptides may improve acute coronary syndrome (ACS) diagnosis with a single blood draw and provide physiologic information regarding underlying heart disease. We evaluate the value of adding natriuretic peptides (myocyte stress markers) to troponins (myocardial injury markers) for diagnosing ACS in emergency department patients with chest pain.. In 328 patients (53 ± 12 years, 63% men) with an initially negative conventional troponin and nonischemic electrocardiogram who underwent 64-slice cardiac computed tomography (CT), we measured conventional troponin-T (cTnT), high-sensitivity troponin-T (hsTnT), N-terminal pro-B type natriuretic peptide, and mid-regional pro-atrial natriuretic peptide. ACS was defined as myocardial infarction or unstable angina. CT was evaluated for coronary plaque, stenosis, and regional wall motion abnormality.. Patients with ACS (n = 29, 9%) had higher concentrations of each biomarker compared to those without (all P < .01). Adding natriuretic peptides, especially N-terminal pro-B type natriuretic peptide, to both cTnT or hsTnT improved the C-statistics and net reclassification index for ACS, largely driven by correctly reclassifying events. Dual-negative marker results improved sensitivity (cTnT 38% to 83%-86%, hsTnT 59% to 86%-90%; all P < .01) and negative predictive value (cTnT 94% to 97%-98%, hsTnT 96% to 97%-98%) for ACS. Patients with dual-negative markers had the lowest percentage of CT coronary plaque, stenosis, and regional wall motion abnormality (all P-trend <.001).. Among emergency department patients with low-intermediate likelihood of ACS, combining natriuretic peptides with either conventional or highly-sensitive troponin improved discriminatory capacity and allowed for better reclassification of ACS, findings supported by structural and functional CT results.

Topics: Acute Coronary Syndrome; Adult; Atrial Natriuretic Factor; Biomarkers; Chest Pain; Emergency Service, Hospital; Female; Humans; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Natriuretic Peptides; Peptide Fragments; Sensitivity and Specificity; Tomography, X-Ray Computed; Troponin T

About 25 years ago, a group of researchers demonstrated that there is no such thing as the "hot hand" in professional basketball. When a player hits 5 or 7 shots in a row (or misses 10 in a row), what's at work is random variation, nothing more. However, random causes do not stop players, coaches, fans, and media from talking about and acting on "hot hands," telling stories and making choices that ultimately are based on randomness. The same phenomenon is true in medicine. Some clinical trials with small numbers of events yielded positive findings, which in turn led clinicians, academics, and government officials to talk, telling stories and sometimes making choices that were later shown to be based on randomness. I provide some cardiovascular examples, such as the use of angiotensin receptor blockers for chronic heart failure, nesiritide for acute heart failure, and cytochrome P-450 (CYP) 2C19 genotyping for the acute coronary syndromes. I also review the more general "decline effect," by which drugs appear to yield a lower effect size over time. The decline effect is due at least in part to over interpretation of small studies, which are more likely to be noticed because of publication bias. As funders of research, we at the National Heart, Lung, and Blood Institute seek to support projects that will yield robust, credible evidence that will affect practice and policy in the right way. We must be alert to the risks of small numbers.

Topics: Acute Coronary Syndrome; Angiotensin Receptor Antagonists; Aryl Hydrocarbon Hydroxylases; Clinical Trials as Topic; Cytochrome P-450 CYP2C19; Genotype; Heart Failure; Humans; Natriuretic Agents; Natriuretic Peptide, Brain; Outcome Assessment, Health Care; Probability; Probability Theory; Publication Bias; Randomized Controlled Trials as Topic; Sample Size

Early and adequate risk stratification is essential in patients with suspected acute coronary syndrome (ACS). The aim of the present study was to investigate whether glycogen phosphorylase BB (GPBB) could add prognostic information in the context of contemporary sensitive troponin I determination and B-type natriuretic peptide (BNP). Patients with suspected ACS were consecutively enrolled at 3 German study centers from January 2007 through December 2008. Troponin I, GPBB, and BNP were determined at admission. Follow-up information on the combined end point of death, myocardial infarction, revascularization, and hospitalization owing to a cardiovascular cause was obtained 6 months after enrollment. In total 1,818 patients (66% men) were enrolled of whom 413 (23%) were diagnosed as having acute myocardial infarction and 240 (13%) as having unstable angina pectoris, whereas in 1,165 patients (64%) an ACS could be excluded. Follow-up information was available in 98% of patients; 203 events were registered. GPBB measured on admission predicted an unfavorable outcome with a hazard ratio of 1.24 (p <0.05) in an unadjusted Cox regression model and showed a tendency with a hazard ratio of 1.13 (p = 0.07) in a fully adjusted model. Kaplan-Meier analysis revealed a poorer outcome in patients with increased GPBB levels amendatory to the information provided by troponin I or BNP. In conclusion, GPBB measurement provides predictive information on midterm prognosis in patients with chest pain in addition to BNP and troponin I.

Topics: Acute Coronary Syndrome; Aged; Angina, Unstable; Biomarkers; Case-Control Studies; Chest Pain; Cohort Studies; Female; Glycogen Phosphorylase, Brain Form; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Predictive Value of Tests; Prognosis; Risk Assessment; Sensitivity and Specificity; Severity of Illness Index; Survival Analysis; Troponin T

To explore the relationship between plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) level obtained on admission and global registry of acute coronary events (GRACE) scores and the value for risk stratification in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).. A total of 231 NSTE-ACS patients admitted in our hospital between June 2009 and September 2010 were included [161 patients with unstable angina (UA) and 70 patients with non-ST-segment elevation myocardial infarction (NSTEMI)]. On admission plasma NT-proBNP was measured in all patients. The GRACE risk score were used for risk assessment. Patients were followed up for 6 months and incidence of new or recurrent myocardial infarction, target vessel revascularization, cardiac death, heart failure (MACE) was recorded.. According to GRACE risk stratification, there were 62 low-risk patients, 78 middle-risk patients and 91 high-risk patients. lgNT-proBNP level on admission increased in proportion to increasing risk defined by GRACE risk stratification and lgNT-proBNP positively correlated with GRACE risk score (r = 0.59, P < 0.001). The GRACE risk score was the highest in the fourth NT-proBNP quartile (P < 0.001 vs. lowest, second and third quartiles). GRACE score was significantly higher in patients with NT-proBNP level above the 75 percentile compared patients with NT-proBNP under the 75 percentile (P < 0.001). MACE occurred in 9 [3.9% (9/231)] patients during follow up. ROC analysis showed AUC of on admission NT-proBNP was 0.831 (SE = 0.062, P = 0.001, 95%CI 0.711 - 0.952) and AUC of GRACE risk score was 0.799 (SE = 0.079, P = 0.002, 95%CI 0.644 - 0.954) for predicting the short-term risk of MACE (P = 0.75).. On admission plasma NT-proBNP level parallels GRACE risk score in NSTE-ACS patients, both on admission plasma NT-proBNP level and GRACE risk score are valuable parameters for risk stratification in patients with NSTE-ACS and increased NT-proBNP level and GRACE values are predictors for increased short-term risk of MACE.

Topics: Acute Coronary Syndrome; Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Risk Assessment; Young Adult

The TIMI risk score is a clinical scoring system used to predict mortality in patients following an acute coronary syndrome (ACS). B-type natriuretic peptide (BNP) has also been found to be useful in this setting.. 80 patients (35 men, 45 women) mean (SD) age 70.68 (9.90) years with ACS were studied. Blood was drawn within 12 hours after the onset of ACS and the blood level of BNP was measured using Biosite Triage Cardioprofiler Panel (Biosite Inc., San Diego, CA, USA). Patient's TIMI risk score was recorded and patients were stratified into low (0 - 2), intermediate (3 - 4), and high-risk (5 - 7) groups.. Overall mortality at 18 months was 20% and was related to BNP levels but not the higher TIMI risk scores. Higher BNP levels were related to decreased survival (median (range) ng/mL, survivors: 166 (5 - 4,710) vs. deceased: 1,093.5 (71.3 - 4,840), p < 0.001). The optimal cutoff for the prediction of survival was 250 ng/mL. ACS patients with BNP over this cutoff have demonstrated the lower survival (log rank p < 0.001).. BNP measurement within the first 12 hours following an ACS is more easily performed and is more accurate than a clinical risk score at predicting long term mortality.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Death; Female; Humans; Male; Myocardial Infarction; Natriuretic Peptide, Brain; Predictive Value of Tests; Risk Assessment; Risk Factors; Severity of Illness Index; Survival Rate; Thailand; Thrombosis; Time Factors

B-type natriuretic peptide (BNP) has been used recently as a biological marker in patients with coronary artery disease (CAD) with ST-elevation, as well as without ST-elevation. BNP is able to predict systolic dysfunction, adding new prognostic information to existing traditional markers. However is not known if there is a relation between the quantity of BNP levels and the severity of coronary artery disease.. This study compared B-type natriuretic peptide (BNP) levels in patients with stable angina (SA) and acute coronary syndromes (ACS) without ST-elevation in relation to angiographic lesions using TIMI and Gensini Scores. We studied 282 patients with CAD without ST elevation and preserved systolic function. BNP samples were measured in all recruited patients within 24 hours of hospitalization.. BNP values were progressively increased in relation to the severity of diagnosis: SA (52.6±49.4 pg/mL ) UA (243.3±212 pg/mL) NSTE-ACS (421.7±334 pg/mL) (p<0.0001 and p<0.007 respectively). No statistically significant difference was observed between patients with SA and controls (21.2±6.8 pg/mL). The analysis of BNP levels in relation to the number of involved vessels demonstrated significantly increased levels in patients with multivessel disease compared to patients with 1 or 2 vessel disease (1-86.2±46.3 pg/mL; 2-127±297 pg/mL; 3-295±318 pg/mL; 4-297±347 pg/mL p<0.001 and p<0.003). Evaluation of BNP using Gensini Score showed a strong relation between BNP and coronary disease extension (r=0.38 p<0.0001).This trend was maintained in all CAD groups (SA=r 0.54; UA r=0.36 NSTE-ACS r=0.28).. Circulating BNP levels appear elevated in ACS with diffuse coronary involvement, even in the absence of systolic dysfunction. BNP is also associated with multi-vessel disease and the extension of coronary disease.

Topics: Acute Coronary Syndrome; Aged; Angina, Unstable; Biomarkers; Coronary Angiography; Coronary Artery Disease; Female; Heart; Humans; Male; Natriuretic Peptide, Brain; Prognosis; Severity of Illness Index; Systole; Ventricular Function, Left

Most patients presenting to the emergency department with possible cardiac symptoms have low cardiac troponin (cTn) concentrations. A combination of biomarkers that improves risk stratification in patients at very low risk for major adverse cardiovascular events (MACEs) would be beneficial. In this multicenter prospective cohort study, specimens from 598 subjects presenting to 5 emergency departments with suspected acute coronary syndromes were collected on arrival and serially for traditional and novel biomarkers. Subjects were evaluated for MACEs, defined as death, myocardial infarction, or revascularization at 30 and 365 days. Classification and regression tree analysis assessed biomarker and clinical factors associated with MACEs. The 1-year rate of MACE was 10.5% (47 of 449). Rates of death, myocardial infarction, and revascularization were 4.2%, 1.6%, and 4.7%, respectively. The combination of B-type natriuretic peptide (BNP), placental growth factor (PlGF), and estimated glomerular filtration rate (eGFR) was the most accurate predictor of MACEs compared to any other biomarker or clinical factors including cTnI. If BNP was ≤ 65 ng/L and PlGF was ≤ 19.5 ng/L, the negative predictive value for 1-year MACEs was 99.1%. Conversely, BNP >150 ng/L and eGFR ≤ 68 ml/min/1.73 m(2) predicted a very high (36.5%) MACE rate. Prognostic values of BNP and PlGF were incremental (none increased, 2 of 212, 0.9%; only PlGF increased, 30 of 170, 17.6%; only BNP increased, 33 of 153, 21.6%; BNP and PlGF increased, 18 of 86, 20.9%). Considering only initial emergency department samples, 97% and 96% of patients with normal PlGF, BNP, and cTnI levels were event-free at 30 and 365 days, respectively. In conclusion, the combination of BNP, PlGF, and eGFR is the most accurate in risk-stratifying patients with suspected acute coronary syndrome.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Chi-Square Distribution; Emergency Service, Hospital; Female; Glomerular Filtration Rate; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Placenta Growth Factor; Predictive Value of Tests; Pregnancy Proteins; Prognosis; Prospective Studies; Regression Analysis; Risk Assessment; Risk Factors

Topics: Acute Coronary Syndrome; Biomarkers; Chest Pain; Humans; Immunoassay; Myocardial Ischemia; Natriuretic Peptide, Brain; Protein Sorting Signals; Sensitivity and Specificity

Topics: Acute Coronary Syndrome; Biomarkers; Humans; Immunoassay; Myocardial Ischemia; Natriuretic Peptide, Brain; Protein Sorting Signals; Sensitivity and Specificity

To compare the accuracy of the GRACE score, a strong prognosticator in acute coronary syndrome (ACS) that is calculated using conventional cardiac troponin (cTn) assays, with that calculated with high-sensitivity cTn (hs-cTn) and with the combination of the GRACE score with hs-cTn or B-type natriuretic peptide (BNP).. Prospective international cohort. Settings University Hospital.. Patients enrolled in the Predictors of Acute Coronary Syndromes Evaluation prospective study with proven ACS. Main outcome measured The capacity to predict in-hospital mortality, 1-year mortality and combined death/acute myocardial infarction (AMI) at 1 year.. 370 patients were enrolled (173 with unstable angina and 197 with AMI). In-hospital mortality was 4.1%; 1-year mortality was 12.5%. The GRACE score was significantly higher in patients who died than in those discharged alive (200 (174-222) vs 125 (98-155); p<0.001), and in those who died than in those who survived for 1 year (151 (133-169) vs 104 (85-125); p<0.001). The area under the curve of the GRACE score was 0.87 regarding in-hospital mortality and 0.88 for 1-year mortality; if calculated with hs-cTn, it was 0.87 and 0.88, respectively (p=NS for all comparisons). The addition of hs-cTn to the GRACE score resulted in no increased value, whereas the addition of BNP tended to improve 1-year mortality prediction (p=0.058).. The GRACE score is accurate for determining both in-hospital and long-term mortality in patients with ACS in the era of hs-cTn. The addition of hs-cTn or BNP to the GRACE score does not significantly improve risk prediction.

Topics: Acute Coronary Syndrome; Aged; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Prognosis; Prospective Studies; Treatment Outcome; Troponin

Myocardial ischemia is a strong trigger of B-type natriuretic peptide (BNP) release. As ischemia precedes necrosis in acute myocardial infarction, we hypothesized that BNP might be useful in the early diagnosis and risk stratification of patients with acute chest pain.. In a prospective, international multicenter study, BNP was measured in 1075 unselected patients with acute chest pain. The final diagnosis was adjudicated by 2 independent cardiologists. Patients were followed long term regarding mortality.. Acute myocardial infarction was the adjudicated final diagnosis in 168 patients (16%). BNP levels at presentation were significantly higher in acute myocardial infarction as compared with patients with other diagnoses (median 224 pg/mL vs. 56 pg/mL, P <.001). The diagnostic accuracy of BNP for the diagnosis of acute myocardial infarction as quantified by the area under the receiver operating characteristic curve (AUC) (0.74; 95% confidence interval [CI], 0.70-0.78) was lower compared with cardiac troponin T at presentation (AUC 0.88; 95% CI, 0.84-0.92; P <.001). Cumulative 24-month mortality rates were 0.5% in the first, 2.1% in the second, 7.0% in the third, and 22.9% in the fourth quartile of BNP (P <.001). BNP predicted all-cause mortality independently of and more accurately than cardiac troponin T: AUC 0.81 (95% CI, 0.76-0.86) versus AUC 0.70 (95% CI, 0.62-0.77; P <.001). Net reclassification improvement for BNP was 0.10 (P=.04), and integrated discrimination improvement 0.068 (P=.01).. BNP accurately predicts mortality in unselected patients with acute chest pain independently of and more accurately than cardiac troponin T, but does not seem to help in the early diagnosis of acute myocardial infarction.

Topics: Acute Coronary Syndrome; Aged; Aged, 80 and over; Analysis of Variance; Angina Pectoris; Biomarkers; Chest Pain; Disease-Free Survival; Early Diagnosis; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Odds Ratio; Predictive Value of Tests; Risk Factors; Troponin T

We hypothesized that measurement of B-type natriuretic peptide could identify patients with non-ST elevation acute coronary syndromes at high risk for complications during beta-blocker (esmolol) infusion.. We reviewed the records of 340 consecutive patients admitted with a non-ST elevation acute coronary syndrome. Seventy three (47 males, aged 62 ± 14 years) received esmolol up to a maximum dose of 300 μg/ kg/min until the symptoms were relieved or an adverse event occurred.. The median infusion rate at steady state was 175 μg/kg/min (median infusion time 18 h). Infusion was halted in 14 patients. The frequency of drug discontinuation increased across admission BNP quartiles. BNP > 141 pg/ml at admission had a 95% predictive value for subsequent withdrawal of esmolol. The presence of BNP > 141 pg/ml in combination with systolic blood pressure < 130 mmHg and left ventricular ejection fraction < 50% identified a group of patients at high risk for drug interruption (interruption frequency = 83%, 95% CI: 55-95%).. In conclusion, BNP measurement in combination with systolic blood pressure and 2D echocardiography may identify patients with non-ST elevation acute coronary syndromes at high risk for adverse events during esmolol infusion.

Topics: Acute Coronary Syndrome; Adrenergic beta-1 Receptor Antagonists; Arrhythmias, Cardiac; Biomarkers; Blood Pressure; Drug Administration Schedule; Echocardiography; Female; Greece; Humans; Infusions, Intravenous; Male; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Propanolamines; Retrospective Studies

Prognostication of the course of disease in patients with high risk of unfavorable outcome of ischemic heart disease (IHD) is of great importance for creation of individualized strategy of treatment. We have investigated contribution of levels of brain natriuretic peptide (BNP) and genetic factors in the risk of development of complications of atherosclerosis in patients who have had acute coronary syndrome. We started to follow 324 patients on day 10 of stable state after acute coronary syndrome (55.1% with Q-wave myocardial infarction, 18.5% with non-Q myocardial infarction, 25.5% with unstable angina, men BNP level 624.5+/-32.13 mol/ml [70.3 - 4276.6]). Duration of followup was 2 years. Baseline BNP level in patients with unfavorable outcome during followup (fatal and nonfatal myocardial infarction and stroke) was 872.47+/-91.42 compared with 592.45+/-35.97 mol/ml in patients without unfavorable outcome (p=0,001). Multifactorial Cox analysis showed that carriage of T allele of polymorphic marker (--1654) of protein C gene, elevated BNP level, symptomatic atherosclerosis of peripheral arteries, history of MI, and use of thiazide diuretics were independently associated with unfavorable outcomes (p=0.026, <0.0001, <0.0001, =0.001, =0.024, respectively). Thus genetic factors and study of BNP allow to improve prediction of unfavorable outcome after exacerbation of IHD.

Topics: Acute Coronary Syndrome; Alleles; Coronary Angiography; DNA; Electrocardiography; Female; Follow-Up Studies; Humans; Immunoenzyme Techniques; Male; Middle Aged; Natriuretic Peptide, Brain; Polymerase Chain Reaction; Polymorphism, Genetic; Prognosis; Protein C; Time Factors

Topics: Acute Coronary Syndrome; Biomarkers; Humans; Interleukin-10; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis

N-terminal proB-type natriuretic peptide (NT-proBNP) is a marker of biomechanical strain, secreted by cardiomyocytes in response to ischemia. As necrosis occurs after prolonged ischemia, a rise in NT-proBNP concentration could precede a rise in markers of necrosis.. The aim of the study was to evaluate whether NT-proBNP is able to identify those patients with an evolving myocardial infarction (MI) with high-risk non-ST-elevation acute coronary syndromes (NSTE-ACS). Data were analyzed from a prospective cohort of 103 high-risk NSTE-ACS patients admitted within 6 h after onset of pain and treated with an early invasive strategy. NT-proBNP samples, obtained immediately upon admission, were related to the presence of an in hospital MI. The optimal cut-off value for NT-proBNP was determined using receiver-operating characteristics (ROC) curve analysis.. Analyses was performed separately for creatinine kinase MB-mass (CKMB) and troponin T (TnT) based MI definitions. In both cases, a NT-proBNP concentration above 40 pmol/L (339 ng/L) at admission proved to be independently associated with the presence of MI. The diagnostic odds ratio (OR) for CKMB-MI was 4.9 (confidence interval 2.0-11.9, p<0.001). The diagnostic OR for TnT-MI was 4.9 (1.8-14.4, p=0.003). Adjusting for differences in baseline variables did not weaken the diagnostic OR. In addition, elevated NT-proBNP concentrations were related to unfavour-able demographic, physical and biochemical parameters.. With a dichotomous cut-off value, a single elevated NT-proBNP (>40 pmol/L) at admission provides independent information about the presence of MI in high-risk NSTE-ACS patients.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Cohort Studies; Creatine Kinase, MB Form; Early Diagnosis; Electrocardiography; Female; Humans; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Odds Ratio; Peptide Fragments; Prospective Studies; Risk Factors; ROC Curve; Troponin T

Topics: Acute Coronary Syndrome; Female; Humans; Male; Natriuretic Peptide, Brain; Troponin

PURPOSE OR BACKGROUND: Interleukin (IL)-10 is an immunoregulatory cytokine that is produced by a variety of cell types, such as macrophages and activated monocytes. IL-10 possesses numerous anti-inflammatory, anti-thrombotic and anti-atherosclerotic properties. Furthermore, patients with acute coronary syndrome have been demonstrated to have reduced levels of IL-10 compared to their stable counterparts. For these reasons, it has been proposed that IL-10 plays a protective role in both atherogenesis and plaque vulnerability. However, 2 short-term studies on the prognostic utility of IL-10 in patients with acute coronary syndrome have provided conflicting results, with one study showing that reduced levels of IL-10 were predictors of adverse outcomes and another showing that elevated levels predicted poor outcomes. The objective of the present study was to investigate the long-term prognostic significance of baseline IL-10 levels in patients with acute coronary syndrome.. Baseline plasma IL-10 levels were measured in 193 well-characterized male patients with acute coronary syndrome who were referred for coronary angiography and followed prospectively for 5 years for the development of major adverse cardiovascular events.. After controlling for a variety of baseline variables (including established biomarkers such as high-sensitivity C-reactive protein and N-terminal-pro-B-type natriuretic peptide), plasma IL-10 levels (whether analyzed as a continuous variable or as a categorical variable using receiver operating characteristic-derived cut point) were a strong and independent predictor of the composite outcome of death or non-fatal myocardial infarction when using a Cox proportional hazards model.. These data demonstrate that, despite biologic plausibility for IL-10 as being a cardioprotective cytokine, elevated baseline plasma levels of IL-10 are a strong and independent predictor of long-term adverse cardiovascular outcomes in patients with acute coronary syndrome.

Topics: Acute Coronary Syndrome; Aged; Angina, Unstable; Biomarkers; C-Reactive Protein; Confounding Factors, Epidemiologic; Hospitals, Veterans; Humans; Interleukin-10; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Myocardial Infarction; Natriuretic Peptide, Brain; New York City; Peptide Fragments; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Prospective Studies; Risk Assessment; Risk Factors; ROC Curve; Time Factors; Treatment Outcome

Laboratory tests contribute to patient length of stay in the emergency department. Therefore, rapid tests performed at the bedside (POCT or point of care testing) are attractive because they allow the emergency physician to obtain immediate biological, diagnostic and/or prognostic data. Userfriendly and with validated analytical performance, POCT have the potential to reduce laboratory time, patient length of stay and time to treatment or disposition. The expected benefit from POCT implementation will depend on the type of patients involved (inpatient or outpatient), their clinical condition and their overall care. Furthermore, logistical and economic implications should also be taken into account.

Topics: Acute Coronary Syndrome; Antifibrinolytic Agents; Biomarkers; Critical Care; Diabetes Complications; Diabetes Mellitus, Type 2; Emergency Service, Hospital; Fibrin Fibrinogen Degradation Products; Heart Failure; Hospital Costs; Humans; Length of Stay; Natriuretic Peptide, Brain; Point-of-Care Systems; Predictive Value of Tests; Prognosis; Pulmonary Disease, Chronic Obstructive; Pulmonary Embolism; Risk Assessment; Sensitivity and Specificity; Switzerland; Treatment Outcome; Troponin

Several mechanisms are involved in the pathophysiology of the Acute Coronary Syndrome (ACS). We have addressed whether B-type natriuretic peptide (BNP) and high-sensitive C-reactive protein (hsCRP) in admission samples may improve risk stratification in chest pain patients with suspected ACS.. We included 982 patients consecutively admitted with chest pain and suspected ACS at nine hospitals in Salta, Northern Argentina. Total and cardiac mortality were recorded during a 2-year follow up period. Patients were divided into quartiles according to BNP and hsCRP levels, respectively, and inter quartile differences in mortality were statistically evaluated applying univariate and multivariate analyses.. 119 patients died, and the BNP and hsCRP levels were significantly higher among these patients than in survivors. In a multivariable Cox regression model for total death and cardiac death in all patients, the hazard ratio (HR) in the highest quartile (Q4) as compared to the lowest quartile (Q1) of BNP was 2.32 (95% confidence interval (CI), 1.24-4.35), p = 0.009 and 3.34 (95% CI, 1.26-8.85), p = 0.015, respectively. In the TnT positive patients (TnT > 0.01 ng/mL), the HR for total death and cardiac death in Q4 as compared to Q1 was 2.12 (95% CI, 1.07-4.18), p = 0.031 and 3.42 (95% CI, 1.13-10.32), p = 0.029, respectively.The HR for total death for hsCRP in Q4 as compared to Q1 was 1.97 (95% CI, 1.17-3.32), p = 0.011, but this biomarker did not predict cardiac death (p = 0.21). No prognostic impact of these two biomarkers was found in the TnT negative patients.. BNP and hsCRP may act as clinically useful biomarkers when obtained at admission in a population with suspected ACS.

Topics: Acute Coronary Syndrome; Aged; Argentina; C-Reactive Protein; Chest Pain; Emergency Medical Services; Female; Follow-Up Studies; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Prognosis; Prospective Studies; Risk Adjustment; Survival Analysis; Troponin

Topics: Acute Coronary Syndrome; Aged; Aged, 80 and over; Angina, Unstable; Biomarkers; Cohort Studies; Coronary Angiography; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Necrosis; Troponin

Topics: Acute Coronary Syndrome; Americas; Atrial Natriuretic Factor; Biomarkers; Dyspnea; Early Diagnosis; Emergency Service, Hospital; Europe; Heart Diseases; Heart Failure; Humans; Hypertension, Pulmonary; Intensive Care Units; Japan; Myocardial Infarction; Natriuretic Peptide, Brain; Patient Discharge; Peptide Fragments; Practice Guidelines as Topic; Predictive Value of Tests; Prognosis; Survival Rate; Troponin; Ventricular Dysfunction, Left

Non-ST-segment elevation acute coronary syndrome is associated with elevation of brain natriuretic peptide and markers of myocardial necrosis, although its relationship with the TIMI score and left ventricular function are largely unknown.. To evaluate the correlation between plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) and markers of myocardial necrosis [creatine phosphokinase muscle-brain fraction (CK-MB) and troponin I], TIMI risk score and left ventricular ejection fraction in patients with non-ST-segment elevation acute coronary syndrome.. Eighty-seven patients with non-ST-segment elevation acute coronary syndrome were divided into two groups: 37 (42.5%) with unstable angina and 50 (57.5%) with non-ST-segment elevation myocardial infarction.. Left ventricular ejection fraction more than 40% was found in 86.2% of the total sample. Serum levels of NT-proBNP was higher in patients with non-ST elevation myocardial infarction than in those with unstable angina (p<0.001). Increased levels of NT-proBNP were associated with increases in troponin I (rs=0.425, p<0.001), peak CK-MB (rs=0.458, p<0.001) and low left ventricular ejection fraction (rs=-0.345, p=0.002); no correlation was found with the TIMI risk score (rs=0.082, p=0.44). Multivariate analysis revealed that left ventricular ejection fraction and troponin I levels were independently correlated with NT-proBNP levels (p=0.017 and p=0.002, respectively).. Increased levels of NT-proBNP in patients with non-ST-segment elevation acute coronary syndrome are not related exclusively to low left ventricular ejection fraction, but can also be caused by the presence of myocardial ischemia and necrosis.

Topics: Acute Coronary Syndrome; Biomarkers; Creatine Kinase, MB Form; Epidemiologic Methods; Female; Humans; Male; Middle Aged; Myocardium; Natriuretic Peptide, Brain; Necrosis; Peptide Fragments; Risk Assessment; Stroke Volume; Troponin I

Cardiac rehabilitation programmes result in reduced morbidity and mortality and improvement of functional class. Behaviour of natriuretic peptides coupled to these programmes is not well established. Our study's objective is to evaluate the behaviour of natriuretic peptides in a sample of patients undergoing a cardiac rehabilitation programme.. Moderate to high-risk patients undergoing a cardiac rehabilitation programme were included. Demographic and clinical characteristics were recorded. We performed four N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma determinations: on the first and last programme day, before and after training. To evaluate functional capacity, a stress test before and after the exercise programme was performed. Eighty-three patients were included. Exercise produces increased levels of NT-proBNP, although in the last exercise session the increase was lower (35.91 vs. 31.49 ng/ml (P = 0.71)). Patients with left ventricular dysfunction present higher NT-proBNP levels. After the rehabilitation programme we observed a significant improvement of functional capacity by 1.5 METS on average (P = 0.001), but not in the subgroup with lower NT-proBNP levels.. Basal levels of peptides did not change significantly after the programme but rose with the workout, especially in patients with left ventricular dysfunction. Patients with higher baseline levels obtained greater functional recovery. We conclude that NT-proBNP measurement may be useful in selecting patients to perform a cardiac rehabilitation programme.

Topics: Acute Coronary Syndrome; Algorithms; Biomarkers; Exercise Test; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Patient Selection; Peptide Fragments; Sampling Studies; Severity of Illness Index; Treatment Outcome; Ventricular Dysfunction, Left

Topics: Acute Coronary Syndrome; Chest Pain; Female; Humans; Male; Myocardial Infarction; Natriuretic Peptide, Brain

Erythropoietin has been related to adverse prognosis in patients with heart failure, but it is unknown whether it adds prognostic information in acute coronary syndrome.. Plasma erythropoietin was measured on admission with enzyme-linked immunosorbent assay in 627 patients. Patients were divided into three groups depending on their erythropoietin level and followed for myocardial infarction (MI) (median 6 months) and mortality (median 39 months). Cox regression models were used to evaluate erythropoietin compared to clinical variables; age, gender, diabetes, smoking, prior MI, heart failure, hypertension and revascularization. In a second Cox regression model, laboratory markers were assessed; hemoglobin, estimated glomerular filtration rate (eGFR), C-reactive protein (CRP), cardiac troponin T (cTnT) and N-terminal pro-brain-natriuretic peptide (NT-proBNP).. Patients with the highest erythropoietin level (>8.8 mU/mL, n=205) had a 47% increased mortality (HR 1.47, 95% CI 1.04-2.06, p=0.028) when adjusted for clinical variables. Compared to laboratory risk markers, erythropoietin added prognostic information (HR 1.59, 95% CI 1.05-2.38, p=0.027) when adjusted for hemoglobin, eGFR and CRP. Erythropoietin (HR 1.21, 95% CI 0.79-1.86, p=0.387) was no longer significantly associated with mortality when cTnT and NT-proBNP were added. Erythropoietin was not related to the risk of future MI (HR 1.24, 95% CI 0.65-2.33, p=0.513).. Elevated erythropoietin level was associated with increased mortality in patients admitted with possible ACS when adjusted for clinical variables, or for kidney function and hemoglobin. However, erythropoietin does not add prognostic information when markers of myocardial necrosis and dysfunction are available in ACS.

Topics: Acute Coronary Syndrome; Aged; C-Reactive Protein; Erythropoietin; Female; Glomerular Filtration Rate; Hemoglobins; Humans; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Risk Factors; Troponin T

Aim of the study was to assess dynamics of NT proBNP in ACS as well as to analyze effect of different methods of treatment on the level of the parameter and its prognostic value.. Patients aged 30-70 years were included into the study: 52 patients with ST segment elevation ACS (STEACS), 61 patients with non ST-segment elevation ACS (NSTEACS). Control group comprised 20 people of the same age without ischemic heart disease. In all patients serum was taken for subsequent measurement of NT proBNP at admission, on day 3 of hospitalization, and before discharge (days 7-10).. In ACS baseline NT proBNP concentration was significantly higher than in stable angina and in control group. During period of hospitalization NT proBNP level rose in the group of patients with STEACS and fell in the group of patients with NSTEACS. After early restoration of coronary blood flow (less than 4 hours after onset on the pain syndrome) in patients with STEACS dysfunction of the left ventricular myocardium was less pronounced (NT proBNP level was lower). High level of NT proBNP was an unfavorable prognostic factor in ACS irrespective of the selected tactics of treatment.

Topics: Acute Coronary Syndrome; Adult; Aged; Coronary Circulation; Female; Hospitalization; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Protein Precursors; Time Factors

Topics: Acetanilides; Acute Coronary Syndrome; Biomarkers; Enzyme Inhibitors; Humans; Natriuretic Peptide, Brain; Piperazines; Ranolazine; Risk Factors

The cobas h 232 point-of-care analyzer by Roche is the instrument successor of the Cardiac reader allowing the quantitative determination of troponin T, creatine kinase MB, myoglobin, NT-proBNP and D-dimer.. In this study 1329 patients with acute coronary syndromes, heart failure, thromboembolic or other diseases and 945 healthy donors were assessed. Comparisons versus central laboratory methods were carried out with 2379 samples from these individuals; out of these, 1591 samples gave quantitative results within the measuring range and were included in the evaluation.. The point-of-care assays for creatine kinase MB, myoglobin, NT-proBNP and D-dimer were within a relative bias range of -5.9 to +6.9% compared to the laboratory assay. The troponin T assay showed a bias of -11.0% and after change of the calibration procedure of +1.9%. None of the five point-of-care assays had a relative difference between the new system and the precursor device that was higher than +5.0%. Within-series coefficients of variation of patient samples were found in a range from 4.8 to 14.8%. No significant interference was observed with lipemic, hemolytic and icteric blood or at different hematocrit values.. Due to its good analytical agreement with the laboratory methods and with its precursor device, the cobas h 232 system can be reliably used to support on-site decision making for cardiovascular patients in acute and non-acute settings.

Topics: Acute Coronary Syndrome; Calibration; Creatine Kinase, MB Form; Equipment Design; Female; Fibrin Fibrinogen Degradation Products; Heart Diseases; Heart Failure; Humans; Male; Myoglobin; Natriuretic Peptide, Brain; Observer Variation; Peptide Fragments; Point-of-Care Systems; Reference Values; Reproducibility of Results; Thromboembolism; Troponin T

Whereas N-terminal pro-brain natriuretic peptide (NT-proBNP) is approved for risk stratification of patients with acute coronary syndromes (ACS), short-term temporal changes in NT-proBNP concentrations and the optimal time points for sampling are not clear. The purpose of this study was to better define the short-term changes in NT-proBNP in relation to clinical presentation, reperfusion and prognostic value in patients with ACS, as well as to identify the optimum time points for sampling.. We studied daily plasma concentrations of NT-proBNP in 133 unselected patients with myocardial infarction (n=65), stable coronary artery disease (CAD, n=46) and no CAD (n=22) who underwent coronary angiography.. Patients with non-ST-elevation myocardial infarction (NSTEMI) presented with markedly higher NT-proBNP than patients with ST-elevation myocardial infarction (STEMI) [1305 (741-3208) ng/L vs. 170 (70-424) ng/L, p<0.001]. Also, time to presentation from onset of pain was much longer in NSTEMI as compared to STEMI (>48 h vs. <6 h, p<0.001). Patients with NSTEMI also presented with higher NT-proBNP as compared with CAD [224 (98-732) ng/L] and no CAD [47 (26-102) ng/L; p<0.001, NSTEMI vs. both]. Following successful percutaneous coronary intervention [thrombolysis in myocardial infarction (TIMI) 3-flow established], NT-proBNP increased markedly within 24 h in patients with STEMI [718 (379-1338) ng/L, p<0.01 vs. 0 h], whereas no change in NT-proBNP was noted in patients with NSTEMI [1190 (1010-2024) ng/L, p=0.88 vs. 0 h]. In both STEMI and NSTEMI, NT-proBNP decreased significantly 96 h after successful reperfusion [STEMI -52%, 372 (189-610) ng/L, p<0.05; NSTEMI -52%, 613 (365-724) ng/L, p<0.05]. Unsuccessful reperfusion (TIMI<3) was associated with unchanged or increased NT-proBNP. NT-proBNP at 96 h and peak NT-proBNP further displayed a strong correlation with cardiac troponin T (r=0.64 and r=0.54, p<0.001), a marker of infarct size, and NT-proBNP at 96 h was a strong predictor of long-term prognosis (hazard ratio 7.29, p=0.025).. In patients with NSTEMI, NT-proBNP may be increased as high as concentrations usually associated with acute congestive heart failure despite the absence of clinical signs. In contrast, patients with STEMI and short time to presentation may present with completely normal NT-proBNP, but dramatic short-term increases following reperfusion. NT-proBNP reflects ischemic burden, reperfusion success and prognosis, and the current data support repetitive sampling in patients with ACS.

Topics: Acute Coronary Syndrome; Adult; Aged; Angioplasty, Balloon, Coronary; Biomarkers; Coronary Angiography; Coronary Artery Disease; Data Interpretation, Statistical; Female; Humans; Male; Middle Aged; Myocardial Infarction; Myocardial Reperfusion; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Time Factors

To consider whether patients most likely to benefit from ACE inhibition in routine practice after acute coronary syndrome (ACS) may be identified from plasma natriuretic peptide concentrations.. Observational cohort study.. Teaching hospital coronary care unit.. 1725 patients admitted with acute coronary syndrome (56.3% ST elevation ACS; median age 67, range 24-97 years).. Using Cox proportional hazards analysis, we assessed the adjusted predictive value for major adverse cardiac events (MACE) of prescription of an ACE inhibitor, of plasma N-terminal pro B-type natriuretic peptide (NT-proBNP) and for interaction between these factors. To adjust for demographic differences between patients prescribed or not prescribed an ACE inhibitor, a factor correcting for likelihood of ACE inhibitor prescription (propensity score) was included in the analysis.. The primary end point was the occurrence of MACE (death, recurrent myocardial infarction or hospitalisation with heart failure).. During the index admission ACE inhibitor was prescribed for 1267/1725 (73.4%) patients. During follow-up (median 528 days, range 0-3873 days), 534/1725 patients experienced MACE. After covariable adjustment, NT-proBNP showed linear association with risk of MACE (p<0.005), strongest for patients with NT-proBNP in the top quartile of observed values (HR=2.768, p<0.001). Only for patients with NT-proBNP in the top quartile was prescription of ACE inhibitor associated with reduction in risk of MACE (HR=0.532, p=0.003). This association was maintained after correction for propensity scores (HR=0.599, p=0.003).. Prognostic benefit from ACE inhibition was seen only in patients with the most marked elevation of plasma NT-proBNP. Plasma NT-proBNP may be a useful indicator of the appropriateness of individual prescription of ACE inhibitor treatment across the spectrum of ACS.

Topics: Acute Coronary Syndrome; Adult; Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors; Biomarkers; Epidemiologic Methods; Female; Humans; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Young Adult

To assess the value of biochemical marker detection in risk stratification in hospitalized patients with acute coronary syndrome (ACS).. A total of 264 consecutive patients (180 male and 84 female patients) admitted for complaint of chest tightness or/and pain were evaluated for a decision of coronary angiography (CAG) within 24 h after admission. The patients were divided into two groups to receive emergency or elective CAG. The venous blood samples were taken from the patient immediately after admission for detection of amino-terminal pro-brain natriuretic peptide (NT-pro-BNP), high-sensitivity C-reactive protein (hs-CRP), myeloperoxidase (MPO), monocyte chemoattractant protein 1 (MCP-1), intercellular adhesion molecule (sICAM-1), soluble CD40 ligand (sCD40L), matrix metalloproteinase 9 (MMP-9), interleukin-6 (IL-6), interleukin 27 (IL-27) and creatine kinase isoenzyme (CK-MB) were detected.. No significant differences in NT-proBNP, hs-CRP, MPO, sCD40L, and MMP-9 were found between emergency CAG group and elective CAG group (P<0.05). Logistic regression identified significant differences in NT-proBNP, hs-CRP, MPO, IL-27 and CK-MB between the two groups, and a predictive model for risk stratification of ACS was established using these biomarkers. The ROC curves of this predictive model showed an area under the curve of 98.1, suggesting a high predictive value of this model in assessment of the changes or progression of ACS.. Combined detection of the biochemical markers can be helpful for risk stratification of the hospitalized patients with ACS early after admission.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; C-Reactive Protein; Female; Humans; Male; Middle Aged; Models, Statistical; Natriuretic Peptide, Brain; Peroxidase; Predictive Value of Tests; Risk Assessment; Risk Factors; ROC Curve

The purpose of this work was to evaluate the relation between serum glucose levels at hospital admission and left ventricular systolic function in nondiabetic patients with an acute coronary syndrome (ACS). Of the 1000 ACS patients who were consecutively enrolled during 2007-2008, 583 (63 +/- 13 years, 20% females) nondiabetic patients were studied in this work. Of these, 254 presented left ventricular systolic dysfunction (ejection fraction <40%). Biochemical measurements and detailed medical information were recorded in all participants. Patients having glucose levels at hospital admission in the highest tertile (>155 mg/dl) had lower left ventricular ejection fraction (40% vs 45%, P = 0.003), were older (66 +/- 11 vs 61 +/- 13, P = 0.004) and less physically active (49% vs 63%, P = 0.02), had higher troponin (14.7 +/- 39.7 vs 5.6 +/- 13.5, P = 0.03), higher brain natriuretic peptide (510.39 +/- 932.33 vs 213.4 +/- 301.14, P = 0.008), higher C-RP (42.26 +/- 55.26 vs 26.46 +/- 38.18, P = 0.04), lower creatinine clearance levels (68 +/- 33 vs.81 +/- 31, P = 0.009), higher white blood cell count (13 416 +/- 16 420 vs 9310 +/- 3020, P = 0.001), and lower body mass index (26.8 +/- 4 vs 27.2 +/- 4.4, P = 0.07), compared to those in the lowest tertile (<114 mg/dl). The multiadjusted logistic regression analysis revealed that a 10 mg/dl difference in glucose levels was independently associated with 8% (95% confidence interval 2%-14%) higher likelihood of left ventricular systolic dysfunction. Low glucose concentrations at hospital admission in nondiabetic post-ACS patients is a predictor for the appearance of left ventricular dysfunction, and could be a target marker for risk stratification.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Blood Glucose; Body Mass Index; C-Reactive Protein; Creatinine; Female; Greece; Humans; Leukocyte Count; Logistic Models; Male; Middle Aged; Natriuretic Peptide, Brain; Odds Ratio; Patient Admission; Risk Assessment; Risk Factors; Stroke Volume; Systole; Troponin; Ventricular Dysfunction, Left; Ventricular Function, Left

Prognostic factors in acute coronary syndromes have been the subject of interest in cardiology over the last few years. Our study aimed to compare humoral marker concentration shifts (hsCRP, Nt-proBNP) and hemodynamic left ventricular systolic function index changes, determined by means of echocardiography in the first hours of acute coronary syndromes (ACS).. The study comprised 33 patients with ACS without ST segment elevation. Group I consisted of 18 patients (11 men, 7 women aged from 48 to 77, mean age 67+/-35 years) with unstable angina pectoris (uAP). Group II consisted of 15 patients (10 men, 5 women aged from 51 to 80, mean age 70+/-11.9 years) with myocardial infarction without ST segment elevation (NSTEMI). In all patients, Nt-proBNP and hsCRP blood concentrations were determined between the 6th and 12th hours after admission to the intensive coronary care unit. On the 2nd-3rd day, after coronary stabilization, routine echocardiography was performed in each patient to assess left ventricular function.. A positive correlation between hsCRP and Nt-proBNP in uAP was observed in group I. In group II, in patients with NSTEMI no such correlation was observed. There was also no correlation in either study group between humoral (hsCRP and Nt-proBNP) and hemodynamic parameters.. The complex evaluation of the post-ACS prognosis should be multifaceted. It should contain hemodynamic assessment of the left ventricle by means of echocardiography as well as humoral coronary risk markers.

Topics: Acute Coronary Syndrome; Aged; Aged, 80 and over; C-Reactive Protein; Female; Hemodynamics; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Ventricular Function, Left

The Global Registry of Acute Coronary Events (GRACE) risk score is widely recommended for risk assessment in patients with acute coronary syndrome. However, there is limited knowledge regarding the utility of this score for long-term risk prediction in unselected patients with acute chest pain and whether it might be improved by the integration of nonnecrosis biomarkers.. We calculated the GRACE risk score in 453 chest pain patients and assessed its value for risk assessment together with the additive prognostic information obtained from N-terminal pro-B-type natriuretic peptide, C-reactive protein, growth differentiation factor-15 (GDF-15), and cystatin C.. After a median follow-up of 5.8 years, 92 patients (20.7%) had died. The GRACE risk score was significantly higher in patients who died (median 146 vs 93, P < .001) and provided a c-statistic regarding mortality of 0.78. A significant increase of the c-statistic was achieved only after addition of GDF-15 (c-statistic 0.81, P = .003) and, to a minor extent, after addition of cystatin C (c-statistic 0.81, P = .035). Assessment of the integrated discriminative improvement yielded similar results. N-terminal pro-B-type natriuretic peptide had only limited incremental prognostic value, and C-reactive protein was not predictive for outcome.. The GRACE risk score allows for the prediction of mortality in chest pain patients even after almost 6 years of follow-up. However, its predictive value could be further enhanced by the addition of selected nonnecrosis biomarkers, in particular GDF-15 or cystatin C.

Topics: Acute Coronary Syndrome; Aged; Aged, 80 and over; Biomarkers; C-Reactive Protein; Chest Pain; Coronary Care Units; Disease Progression; Electrocardiography; Female; Follow-Up Studies; Growth Differentiation Factor 15; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Necrosis; Peptide Fragments; Prevalence; Prognosis; Protein Precursors; Registries; Retrospective Studies; Risk Assessment; Risk Factors; Salivary Cystatins; Severity of Illness Index; Sweden; Time Factors; Troponin I

We compared the 1-year predictive value of several inflammatory and non-inflammatory biomarkers in ACS patients.. In 610 patients (73.0% male)--36.0% unstable angina (UA) and 64.0% NSTEMI--we assessed high-sensitivity C-reactive protein (hs-CRP), interleukins 6, 10 and 18, soluble CD40 ligand, P- and E-selectin, NT-proBNP, fibrinogen and cystatin C at hospital admission. Two outcomes at 1-year follow up were selected for analysis: (1) all-cause death, MI, UA, or coronary revascularization, and (2) all-cause death, and non-fatal MI. The effect of biomarker levels on endpoints was examined by the Cox proportional hazards model, and their discrimination ability with the C statistic (AUC).. Of 549 patients (90.0%) who completed the 1-year follow up, 206 (37.5%) and 54 (8.9%) reached the first and second composite endpoints, respectively. None of the biomarkers studied improved prediction of the first endpoint. However, considered as continuous variables, and in combination, NT-proBNP and fibrinogen, increased the AUC from 0.64 (95% CI 0.55-0.72) to 0.73 (95% CI 0.64-0.81; p=0.02) for prediction of the second endpoint. Cut-off values for NT-proBNP and fibrinogen, regarding best sensitivity and specificity for prediction of the secondary endpoint were 1043.9 ng/L and 4.47 mg/dL, respectively. For these cut-off points, sensitivity, specificity, positive predictive value and negative predictive value were 40.5% vs 59.5%, 83.3% vs 67.1%, 18.8% vs 14.9% and 93.5% vs 94.4% for NT-proBNP and fibrinogen, respectively.. In ACS patients, inflammatory biomarkers offer modest incremental information to that provided by clinical risk markers. Fibrinogen and NT-proBNP measurements, however, improve cardiovascular risk prediction.

Topics: Acute Coronary Syndrome; Aged; Angina, Unstable; Area Under Curve; Biomarkers; Cardiovascular Diseases; Female; Humans; Inflammation; Macrophages; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Proportional Hazards Models; Protein Structure, Tertiary; T-Lymphocytes; Time Factors

The aim of this study is to find novel biomarkers for prognosis in patients with acute coronary syndrome (ACS). We enrolled 245 eligible patients with ACS and compared the protein expression between the two groups, with or without major adverse cardiovascular events (MACE). To determine biomarkers for prognosis, we performed mass spectrometry analysis. We found 10 proteins in the serum that can be used to classify ACS with or without MACE and specific protein peaks at m/z 1921.0, 2124.2, and 20887.3 that were increased in patients with MACE. These peaks reliably predict MACE occurrence in patients with ACS, in addition to the widely accepted markers troponin and brain natriuretic peptide precursor. The characteristic changes in the peaks at m/z 1921.09, 2124.2, and 20887.3 correlate with poor prognosis in ACS patients. These proteins could potentially be used as predictive biomarkers to evaluate patient prognosis.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Female; Humans; Male; Mass Spectrometry; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Prognosis; Proteome; Proteomics; Troponin

Arterial calcification is a risk factor for atherosclerosis. Calumenin (CALU), a protein regulating proteins involved in coagulation and arterial calcification also has extracellular functions related to atherosclerosis. We recently described that CALU polymorphism A29809G was related to acenocoumarol requirements, and we wanted to evaluate its role in arterial calcification and prognosis.. A total of 374 consecutive patients with non-ST-elevation acute coronary syndrome (nSTACS). In 175 of them, who underwent percutaneous coronary intervention, we assessed calcification in each main coronary artery. Follow-up at 1 and 6 months was performed for adverse end-points.. CALU 29809G carriers were more frequent in the low calcium group (P = 0.037). The presence of >or=3 cardiovascular risk factors and CALU polymorphism were associated with arterial calcification (OR 2.34, P = 0.049; and OR 0.34, P = 0.019, respectively). CALU 29809G allele was the only variable associated with events at 1 month (HR 0.42; P = 0.042). Multivariate analysis showed that, at 6 months, age and severe anginal symptoms were associated with worse prognosis (HR 2.13, P = 0.023; and HR 2.01, P = 0.011, respectively), whereas CALU 29809G allele associated with good prognosis (HR 0.59, P = 0.044). Our results suggest that CALU A29809G is associated with arterial calcification and short-term prognosis of the outcome of patients with nSTACS.

Topics: Acute Coronary Syndrome; Aged; Aged, 80 and over; Biomarkers; Calcinosis; Calcium-Binding Proteins; Coronary Artery Disease; Female; Genotype; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Polymorphism, Single Nucleotide; Prognosis; Prospective Studies

There have been considerable advances in the evaluation of suspected acute coronary syndromes (ACS): sophistication of the clinical examination, electrocardiography, risk prediction scores, multiple blood biomarkers, and rapid cardiovascular imaging. Integration of information remains a formidable challenge for the physician in the setting of time-sensitive clinical decision making. In addition to conventional panels of biomarkers, there are novel entities that may be able to signal different stages of the acute event, including plaque disruption, atherothrombosis, ischemic damage, tissue hypoxia, and oxidative stress. The natriuretic peptides are normal myocyte products that reflect myocardial tissue response to neurohormonal and mechanical forces that rapidly change during an ACS event. This article summarizes major advancements in the integrative use of multiple blood biomarkers and cardiovascular imaging in the diagnosis, prognosis, and management of ACS.

Topics: Acute Coronary Syndrome; Biomarkers; Fibrosis; Humans; Lipids; Myocardium; Natriuretic Peptide, Brain; Necrosis; Oxidative Stress; Predictive Value of Tests; Prognosis

To determine the additional prognostic value of mitral regurgitation (MR) over B-type natriuretic peptide (BNP), left ventricular ejection fraction (LVEF) and clinical characteristics in patients with acute coronary syndromes (ACS).. Long-term follow-up in a prospective ACS cohort with Doppler-assessed MR, echocardiographically-determined LVEF and plasma BNP levels by ELISA.. Single-centre university hospital.. 725 patients with ACS.. Death and readmission for congestive heart failure.. During a median follow-up of 98 months, 235 patients (32%) died. Significant MR (grade >1 of 4) was found in 90 patients (12%). In a multivariate model including MR grade >1, LVEF <0.40 and BNP >373 pg/ml (75th percentile), MR was significantly associated with long-term mortality (HR 2.28, 95% CI 1.67 to 3.12; p<0.0001). When also adjusting for conventional risk factors, MR remained significantly associated with mortality (HR 1.53, 95% CI 1.06 to 2.19; p=0.02), as well as with congestive heart failure (HR 2.08, 95% CI 1.29 to 3.35; p=0.003).. MR is common in patients with ACS, provides independent risk information and should be taken into account in the evaluation of the long-term prognosis.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Echocardiography, Doppler; Epidemiologic Methods; Female; Heart Failure; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Natriuretic Peptide, Brain; Patient Readmission; Prognosis; Stroke Volume

To analyze Osteoprotegerin (OPG), and BNP plasma levels in patients with non-ST elevation acute coronary syndrome (NSTE-ACS), in relation to clinical presentation and to coronary atherosclerosis diffusion.. 155 CAD patients were classified in four groups: stable angina (SA n=42), unstable angina (UA n=35) non-ST elevation myocardial infarction (NSTEMI n=45) and control group (n=33), measuring OPG and BNP at hospital admission. We compared both biomarkers in relation to the number of coronary narrowed vessels (1-,2-,3 or more vessels disease), and to the stenoses degree by Duke Jeopardy score.. OPG levels were higher in patients with CAD respect to controls (p<0.0001). Patients with SA showed more elevated levels than controls (2.6+/-1.2 vs 7.4+/-5.0 pmol/l p<0.01). However patients with UA and NSTEMI had higher OPG level with respect to SA patients (12.2+/-7.8 and 11.6+/-6.1 respectively pmol/l p<0.001). A positive relation was found between OPG levels and coronary plaques extension by Duke Jeopardy score (r=0.65). BNP levels were higher in patients with UA/NSTEMI respect to controls and SA patients (p<0.001). Besides, BNP was significantly higher in patients with multi-vessels vs 1-vessel disease (p<0.001).. Patients with UA and NSTEMI show high OPG and BNP levels. OPG increase seems related to the number of plaques in the coronary vessels, suggesting its involvement in the CAD progression.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Case-Control Studies; Coronary Artery Disease; Enzyme-Linked Immunosorbent Assay; Female; Humans; Male; Natriuretic Peptide, Brain; Osteoprotegerin; Regression Analysis; Risk Factors; Systole

To determine whether circulating levels of chromogranin A (CgA) provide prognostic information independently of conventional risk markers in acute coronary syndromes (ACSs).. We measured circulating CgA levels on day 1 in 1268 patients (median age 67 years, 70% male) with ACS admitted to a single coronary care unit of a Scandinavian teaching hospital. The merit of CgA as a biomarker was evaluated after adjusting for conventional cardiovascular risk factors. During a median follow-up of 92 months, 389 patients (31%) died. The baseline CgA concentration was strongly associated with increased long-term mortality [hazard ratio per 1 standard deviation increase in logarithmically transformed CgA level: 1.57 (1.44-1.70), P < 0.001], heart failure hospitalizations [1.54 (1.35-1.76), P < 0.001], and recurrent myocardial infarction (MI) [1.27 (1.10-1.47), P < 0.001], but not stroke. After adjustment for conventional cardiovascular risk markers, the association remained significant for mortality [hazard ratio 1.28 (1.15-1.42), P < 0.001] and heart failure hospitalization [hazard ratio 1.24 (1.04-1.47), P = 0.02], but not recurrent MI.. CgA is an independent predictor of long-term mortality and heart failure hospitalizations across the spectrum of ACSs and provides incremental prognostic information to conventional cardiovascular risk markers.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Chromogranin A; Echocardiography; Female; Follow-Up Studies; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Proportional Hazards Models; Prospective Studies

Cardiac troponin is the preferred biomarker for detecting acute myocardial injury and infarction (MI). We studied whether multiple biomarkers of numerous pathophysiological pathways would increase the diagnostic accuracy for detecting MI.. Seven biomarkers [myeloperoxidase, soluble CD40 ligand, placental growth factor, matrix metalloproteinase 9 (MMP-9), high-sensitivity C-reactive protein (hsCRP), cardiac troponin I (cTnI), N-terminal pro-B-type natriuretic peptide] and estimated glomerular filtration rate were measured in 457 patients presenting on admission with symptoms suggestive of acute coronary syndrome. Twenty-five patients (5.4%) received MI diagnoses. Clinical sensitivities and specificities were evaluated from 99th-percentile reference values. Forward and backward stepwise logistic regression modeling techniques were used to identify biomarkers that were independently predictive of MI.. Biomarker sensitivities ranged from 20% to 96%, and specificities ranged from 19% to 89%. MMP-9 had the highest sensitivity, but its specificity was 19%. cTnI demonstrated a sensitivity of 72% (95% CI, 51%-88%) and a specificity of 89% (95% CI, 85%-92%). In multivariate models, cTnI (P < 0.001) and either hsCRP (P = 0.009) or MMP-9 (P = 0.03) were independently predictive of MI. Addition of hsCRP or MMP-9 increased the specificity to 95% (95% CI, 92%-97%) or 91% (95% CI, 88%-94%), respectively, but reduced the sensitivity to 56% (95% CI, 35%-76%) and 68% (95% CI, 47%-85%) relative to cTnI alone.. Our findings indicate that the most clinically accurate biomarker for the early diagnosis of MI is the use of cTnI alone, rather than a multiple-biomarker approach, when an analytically robust cardiac troponin assay based on the 99th percentile is used.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; C-Reactive Protein; CD40 Ligand; Enzyme-Linked Immunosorbent Assay; Female; Glomerular Filtration Rate; Humans; Logistic Models; Male; Matrix Metalloproteinase 9; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Peroxidase; Placenta Growth Factor; Pregnancy Proteins; Risk Assessment; Sensitivity and Specificity; Solubility; Troponin I

Topics: Acute Coronary Syndrome; Biomarkers; C-Reactive Protein; Evidence-Based Medicine; Heart Failure; Hospitalization; Humans; Natriuretic Peptide, Brain; Predictive Value of Tests; Time Factors

The GRACE (Global Registry of Acute Coronary Events) risk score has been shown to offer predictive power with regard to death and AMI (acute myocardial infarction) in patients with ACS (acute coronary syndromes). NT-proBNP (N-terminal pro-B-type natriuretic peptide) has also been found to be useful in predicting mortality following ACS. In the present study, we sought to investigate the use of the GRACE score and NT-proBNP levels at predicting risk of early and late deaths following ACS. We studied 1033 patients (740 men, mean age 66.5+/-12.7 years) with AMI. Blood was drawn once within 24 h following the onset of chest pain. The plasma concentration of NT-proBNP was determined using an in-house non-competitive immunoassay. Patients were GRACE risk scored. The 30-day mortality was 3.7% and the 6-month mortality was 7.8%, and all were related to higher GRACE risk scores (P=0.001 for trend). Higher NT-proBNP levels were also related to increased mortality (P<0.0001). In a Cox proportional hazards model, independent predictors of 30-day and 6-month mortality included NT-proBNP levels and the GRACE risk score. The receiver-operating curve for the GRACE risk score was complemented by NT-proBNP levels for prediction of 30-day mortality [AUC (area under the curve), 0.85] and 6-month mortality (AUC, 0.81). NT-proBNP gives complementary information to the GRACE risk score for predicting early and late mortality. The inclusion of the NT-proBNP blood test is useful in risk-stratifying patients after ACS.

Topics: Acute Coronary Syndrome; Adult; Aged; Aged, 80 and over; Biomarkers; Epidemiologic Methods; Female; Humans; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Young Adult

Plasma adiponectin is inversely associated with the risk of coronary heart disease in healthy people. However, adiponectin and BNP (B-type natriuretic peptide) are both known to be positively associated with a risk of poor outcome, and with each other, in ACS (acute coronary syndrome) patients. Serial changes in plasma adiponectin and BNP following ACS have not been assessed previously, and may clarify these apparently paradoxical associations. In the present study, adiponectin, BNP, classical risk markers and clinical parameters were measured in plasma from 442 consecutive ACS patients in an urban teaching hospital, with repeat measures at 7 weeks (n=338). Patients were followed-up for 10 months. Poor outcome was defined as mortality or readmission for ACS or congestive heart failure (n=90). In unadjusted analysis, the change in adiponectin (but not baseline or 7-week adiponectin) was significantly associated with the risk of an adverse outcome {odds ratio (OR), 5.42 [95% CI (confidence interval), 2.78-10.55]}. This association persisted after adjusting for classical risk factors and clinical markers, but was fully attenuated by adjusting for the 7-week BNP measurement [OR, 1.13 (95% CI, 0.27-4.92)], which itself remained associated with risk [OR, 5.86 (95% CI, 1.04-32.94)]. Adiponectin and BNP positively correlated at baseline and 7 weeks, and the change in both parameters over 7 weeks also correlated (r=0.39, P<0.001). In conclusion, increases in plasma adiponectin (rather than absolute levels) after ACS are related to the risk of an adverse outcome, but this relationship is not independent of BNP levels. The results of the present study allude to a potential direct or indirect relationship between adiponectin and BNP post-ACS which requires further investigation.

Topics: Acute Coronary Syndrome; Adiponectin; Biomarkers; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Prognosis; Risk Factors; Ventricular Dysfunction, Left

We evaluated the prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) for further risk stratification of intermediate-risk patients with non-ST elevation acute coronary syndromes (NSTE-ACS).. The study included 137 intermediate-risk patients (85 men, 52 women; mean age 62+/-11 years) with ACS, based on the TIMI risk score (scores 3 to 5). Serum NT-proBNP levels were measured 12 hours after the last anginal episode. The patients were divided into four groups according to the following NT-proBNP quartiles: 17-310 pg/ml (n=34), 313-688 pg/ml (n=35), 724-2,407 pg/ml (n=34), and 2,575-24,737 pg/ml (n=34). Primary endpoint of the study was mortality. The mean follow-up was 21.8+/-7.1 months.. There were 27 deaths (19.7%), 14 of which were in the 4th quartile (4th vs 1st, 2nd, and 3rd quartiles: p=0.02, p=0.01, and p<0.01, respectively). The first three quartiles did not differ significantly in this respect. In Kaplan-Meier analysis, patients in the 4th quartile had the lowest cumulative survival (log rank test, 4th vs 1st, 2nd, and 3rd quartiles: p=0.041, p=0.026, and p=0.009, respectively). NT-proBNP level was significantly higher in nonsurvivors than in survivors (p=0.01). In univariate analysis, mortality was also associated with the TIMI risk score, ejection fraction, and age. Patients who died were older (65.6+/-11.9 years vs 60.7+/-11.0 years; p=0.048) and had a lower ejection fraction (46.3+/-11% vs 54.1+/-9.8%; p<0.001) than patients who survived. Mortality rates corresponding to TIMI risk scores of 3, 4, and 5 were 25.9%, 29.6%, and 44.4%, respectively (p=0.58 for TIMI 3 vs 4; p=0.001 for TIMI 3 vs 5; p=0.013 for TIMI 4 vs 5). Cox proportional hazards regression analysis showed that only TIMI risk score was an independent predictor of mortality (hazard ratio 2.3, 95% confidence interval 1.4-3.8, p=0.001).. NT-proBNP has an additive predictive value over TIMI risk score in predicting long-term mortality in intermediate-risk patients with ACS.

Topics: Acute Coronary Syndrome; Aged; Analysis of Variance; Angioplasty, Balloon, Coronary; Coronary Angiography; Coronary Artery Bypass; Female; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Proportional Hazards Models; Prospective Studies; Risk Factors; Survival Rate

BACKGROUND; The wide variability of NT-proBNP levels in acute coronary syndromes could arise from sympathetic activation and glomerular impairment. The aim of the study was to investigate, in this setting, the dependence of NT-proBNP from Chromogranin A (CgA) and Cystatin C (CC) levels, respectively assessing sympathetic activation and glomerular impairment.. In 132 patients, 90 ST elevation acute coronary syndrome (STE-ACS) and 42 non ST elevation acute coronary syndrome (NSTE-ACS), within 24 h from symptoms and with creatinine levels lower than 141.4 micromol/L, we measured NT-proBNP, CgA and CC levels. In 41 STE-ACS patients we evaluated the kinetic profiles of the markers.. From the multiple regression model, to investigate the dependence of NT-proBNP from CgA, CC levels, time from symptoms, STE-ACS/NSTE-ACS subsets, gender, adjusting for the effect of left ventricular ejection fraction and age we had evidence of: 1) interactions involving the subsets, the first with CgA levels and the second with age; 2) non linear increasing effect of the delay on NT-proBNP secretion.. Our data showed that, in the population studied, sympathetic activation and age could affect NT-proBNP secretion yielding different secretory patterns in STE- or NSTE-ACS. Only for STE-ACS we observed higher marker secretion in older patients.

Topics: Acute Coronary Syndrome; Adult; Age Factors; Aged; Aged, 80 and over; Chromogranin A; Cystatin C; Female; Humans; Kinetics; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments

The prognostic importance of early measurement of B-type natriuretic peptide (BNP) in patients with acute chest pain while the diagnosis is still uncertain is unknown. We determined the prognostic value of BNP in these patients immediately after presenting to the emergency department.. Seven hundred and twenty-three consecutive individuals with suspicious ischemic acute chest pain and no ST-segment elevation were prospectively evaluated using a systematic diagnostic strategy and followed for 1 year. Acute coronary syndrome was diagnosed in 326 patients during their hospital stay.. In the follow-up, 15 (2.1%) patients of the whole cohort died of cardiac cause at 1 month and 51 (7.1%) at 1 year. Patients who died had significantly higher admission BNP levels than survivors and this correlation proved linear according to quartile levels. Patients with BNP greater than 101 pg/ml had 13 times higher rate of 1-month mortality (P<0.0001) and 5.3 times higher rate of 1-year mortality (P<0.0001) than patients with BNP of 101 pg/ml or less. Multiple logistic regression analysis disclosed BNP as a strong independent predictor of 1-month and 1-year mortality adding significant prognostic information over traditional risk markers.. Admission BNP is an independent and powerful marker of early and late cardiac mortality in patients with acute chest pain without ST-segment elevation. These results suggest that BNP should be measured upon arrival at the emergency department for risk stratification in all these patients.

Topics: Acute Coronary Syndrome; Acute Disease; Aged; Aged, 80 and over; Angina Pectoris; Biomarkers; Emergency Service, Hospital; Female; Follow-Up Studies; Humans; Logistic Models; Male; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Prognosis; Prospective Studies; Risk Assessment; ROC Curve; Time Factors; Up-Regulation

In acute coronary syndrome (ACS), both the Global Registry of Acute Coronary Events (GRACE) score and B-type natriuretic peptide (BNP) predict cardiovascular events. However, it is unknown how BNP compares with GRACE and how their combination performs in ACS.. The authors recruited 449 consecutive ACS patients and measured admission GRACE score and bedside BNP levels. The main outcome measure was all-cause mortality, readmission with ACS or congestive heart failure (defined as a cardiovascular event) at 10 months from presentation.. Of the 449 patients, 120 patients presented with ST-elevation myocardial infarction (MI) (27%). There were 90 cardiovascular events at 10 months. Both higher GRACE terciles and higher BNP terciles predicted cardiovascular events. There was a significant but only partial correlation between the GRACE score and log BNP (R = 0.552, p<0.001). On multivariate analyses, after adjusting for the GRACE score itself, increasing BNP terciles independently predicted cardiovascular events (second BNP tercile adjusted RR 2.28 (95% CI 1.15 to 4.51) and third BNP tercile adjusted RR 4.91 (95% CI 2.62 to 9.22)). Patients with high GRACE score-high BNP were more likely to experience cardiovascular events at 10 months (RR 6.00 (95% CI 2.40 to 14.83)) compared to those with high GRACE score-low BNP (RR 2.40 (95% CI 0.76 to 7.56)).. In ACS, most but not all of our analyses suggest that BNP can predict cardiovascular events over and above the GRACE score. The combined use of both the GRACE score and BNP can identify a subset of ACS patients at particularly high risk. This implies that both the GRACE score and BNP reflect somewhat different risk attributes when predicting adverse prognosis in ACS and their synergistic use can enhance risk stratification in ACS to a small but potentially useful extent.

Topics: Acute Coronary Syndrome; Adult; Aged; Epidemiologic Methods; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain

The N-terminal portion of brain natriuretic peptide (NT-proBNP) has been identified as an indicator of prognosis in different cardiovascular diseases. The objective of this study was to determine the utility of measuring plasma NT-proBNP levels in patients with acute coronary syndromes.. We studied 66 patients admitted in our division for acute coronary syndromes. Patients underwent a venous blood sample within 24 h from the admission to determine NT-proBNP levels. Increasing plasma levels of NT-proBNP (in tertiles) was associated with a greater history of hypertension and current smoking, whereas biochemical parameters were associated with higher level of creatine kinase-MB mass, cardiac troponin I, and renal insufficiency. We detected correlations between the values of NT-proBNP and several variables; positive correlations were found between the values of NT-proBNP and creatinine (r=+0354; P=0.0024), cardiac troponin I levels (r=0320; P=0.0111), and creatine kinase-MB mass values (r=0261; P=0.035). An interesting result of our study was a significantly longer hospitalization in those patients belonging to the third tertile compared with those belonging to the first one (P=0.02). Finally, we showed a higher N-terminal brain natriuretic peptide level in patients with poor outcome during the hospitalization (left-ventricular systolic dysfunction, recurrent ischemic events, or death) compared with those who did not (3204+/-1841 vs. 836+/-1136, P=0.003).. Measurement of B-type natriuretic peptide provides predictive information during the hospitalization in patients with acute coronary syndromes.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Creatine Kinase, MB Form; Creatinine; Female; Hospital Mortality; Humans; Inpatients; Length of Stay; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Recurrence; Risk Assessment; Troponin I; Ventricular Dysfunction, Left

To evaluate levels of carbohydrate antigen-125 (CA-125) in patients with acute coronary syndrome (ACS), with regard to incidence of acute heart failure (AHF) and levels of brain natriuretic peptide (BNP).. In 47 consecutive patients with ACS, circulating levels of CA-125 and BNP were ascertained in the first 24 h and after 3 days of hospitalization. Left ventricular function and in-hospital incidence of AHF were also evaluated.. BNP and CA-125 levels were significantly higher in patients with pulmonary oedema (PO) (564.25+/-500.50 vs. 258.57+/-284.81 pg/ml, P<0.05; 51.78+/-54.71 vs. 13.78+/-12.01 UI/ml, P<0.001) proportionally to Killip class (r=0.44, r=0.47; P<0.01) and were related to LV end-diastolic dimension (r=0.47, P<0.01; r=0.66, P<0.001) and LV ejection fraction (r=-0.63, P<0.001; r=-0.37, P<0.01). CA-125 levels identified patients with PO with higher specificity (97.1 vs. 31.4%), positive predictive value (83.3 vs. 33.3%) and accuracy (83.0 vs. 48.9%) when compared with BNP.. CA-125 levels are increased in patients with ACS and systolic dysfunction or AHF. Patients with PO are better identified by combined BNP and CA-125 assay rather than by only BNP.

Topics: Acute Coronary Syndrome; Acute Disease; Aged; Biomarkers; CA-125 Antigen; Female; Heart Failure; Humans; Male; Membrane Proteins; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Pulmonary Edema; Risk Assessment; Risk Factors; ROC Curve; Sensitivity and Specificity; Stroke Volume; Time Factors; Up-Regulation; Ventricular Function, Left

Many professional societies publish acute intervention guidelines, and most are predicated on the knowledge of an accurate diagnosis. In the emergency department patients do not arrive with a diagnosis, rather they present with symptoms that must be evaluated in the context of their estimated illness severity. Unique to emergency medicine practice, and within a relatively short time frame, all emergency patients must go somewhere else. Appropriate dispositions may be home, admission to a chest pain center, hospitalization to a regular medical floor, or transfer to an intensive care unit, but they cannot stay in the emergency department. This disposition process must occur, even in the setting of great diagnostic uncertainty. Since an accurate diagnosis is a time dependent event, requiring data collection and analysis, emergency department disposition decisions may be based on risk estimates rather than an established diagnosis. Owing to the subjective nature of the early evaluation process, biomarkers currently determine much of the risk stratification process. In this manuscript, we discuss the value of biomarkers as an adjunct to the diagnosis and risk stratification process for patients presenting to the emergency department with suspected acute coronary syndromes and acute heart failure.

Topics: Acute Coronary Syndrome; Biomarkers; Blood Urea Nitrogen; Combined Modality Therapy; Creatine Kinase, MB Form; Emergency Service, Hospital; Heart Failure; Humans; Myoglobin; Natriuretic Peptide, Brain; Risk Assessment; Thrombolytic Therapy; Troponin T

Early identification of acute coronary syndrome (ACS) is important to guide therapy at a time when it is most likely to be of value. In addition, predicting future risk helps identify those most likely to benefit from ongoing therapy. Cardiac troponin T (cTnT) is useful for both purposes although cannot reliably rule out ACS until 12 hours after pain onset and does not fully define future risk. In this review article we summarize our previously published research, which assessed the value of myocyte injury, vascular inflammation, hemostatic, and neurohormonal markers in the early diagnosis of ACS and risk stratification of patients with ACS. In addition to cTnT, we measured heart fatty acid binding protein (H-FABP), glycogen phosphorylase-BB, high-sensitivity C-reactive protein, myeloperoxidase, matrix metalloproteinase 9, pregnancy-associated plasma protein-A, D-dimer, soluble CD40 ligand, and N-terminal pro-brain natriuretic peptide (NT-proBNP). Of the 664 patients enrolled, 415 met inclusion criteria for the early diagnosis of acute myocardial infarction (MI) analysis; 555 were included in the risk stratification analysis and were followed for 1 year from admission. In patients presenting <4 hours from pain onset, initial H-FABP had higher sensitivity for acute MI than cTnT (73% vs. 55%; P=0.043) but was of no benefit beyond 4 hours when compared to cTnT. On multivariate analysis, H-FABP, NT-proBNP, and peak cTnT were independent predictors of 1-year death/MI. Our research demonstrated that, in patients presenting within 4 hours from pain onset, H-FABP may improve detection of ACS. Measuring H-FABP and proBNP may help improve long-term risk stratification.

Topics: Acute Coronary Syndrome; Biomarkers; C-Reactive Protein; CD40 Ligand; Chest Pain; Early Diagnosis; Fatty Acid Binding Protein 3; Fatty Acid-Binding Proteins; Fibrin Fibrinogen Degradation Products; Glycogen Phosphorylase, Brain Form; Humans; Matrix Metalloproteinase 9; Multivariate Analysis; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Peroxidase; Predictive Value of Tests; Pregnancy-Associated Plasma Protein-A; Reproducibility of Results; Risk Assessment; Troponin T

Performance characteristics of the LOCI cTnI, CK-MB, MYO, NTproBNP and hsCRP methods on the Dimension Vista System were evaluated.. Imprecision (following CLSI EP05-A2 guidelines), limit of quantitation (cTnI), limit of blank, linearity on dilution, serum versus plasma matrix studies (cTnI), and method comparison studies were conducted.. Method imprecision of 1.8 to 9.7% (cTnI), 1.8 to 5.7% (CK-MB), 2.1 to 2.2% (MYO), 1.6 to 3.3% (NTproBNP), and 3.5 to 4.2% (hsCRP) were demonstrated. The manufacturer's claimed imprecision, detection limits and upper measurement limits were met. Limit of Quantitation was 0.040 ng/mL for the cTnI assay. Agreement of serum and plasma values for cTnI (r=0.99) was shown. Method comparison study results were acceptable.. The Dimension Vista cTnI, CK-MB, MYO, NTproBNP, and hsCRP methods demonstrate acceptable performance characteristics for use as an aid in the diagnosis and risk assessment of patients presenting with suspected acute coronary syndromes.

Topics: Acute Coronary Syndrome; Biomarkers; C-Reactive Protein; Cardiovascular Diseases; Creatine Kinase, MB Form; Humans; Immunoassay; Myoglobin; Natriuretic Peptide, Brain; Peptide Fragments; Reproducibility of Results; Risk Assessment; Sensitivity and Specificity; Troponin I

Emerging evidence indicates the prognostic importance of cystatin C (Cys-C) in patients with coronary artery disease. However, whether Cys-C concentrations are associated with adverse clinical events among patients with acute coronary syndromes (ACS) have not been studied extensively. We compared the long-term prognostic efficacy of Cys-C with other markers of renal dysfunction, inflammation and systolic dysfunction in patients with ACS.. Serum levels of Cys-C, high sensitive C-reactive protein (hs-CRP), brain natriuretic peptide (BNP) and creatinine were measured in 160 patients with ACS (112 males, 48 females, mean age 60+/-10 years) on admission. Primary end point of the study was major adverse cardiac events (MACE) defined as the combination of cardiac death, non-fatal myocardial infarction and recurrent rest angina that required hospitalization within 12 months of follow-up. During the follow-up period, 42 (26%) patients met the MACE criteria. The occurrence of MACE was significantly higher among patients with higher Cys-C levels. In multivariate analysis, Cys-C was the most important parameter associated with the occurrence of MACE (OR=9.62, 95% CI=2.3-40.5, p<0.001). ROC curve analysis showed that the predictive cut-off value of Cys-C for MACE was 1051ng/ml. In the Cox regression analysis adjusted for multiple risk factors, Cys-C was found as the most powerful predictor for MACE (RR=9.43, 95% CI=4.0-21.8, p<0.001).. The results of the present study indicate that admission levels of Cys-C may be a good prognostic indicator of recurrent cardiovascular events in patients with ACS. Further studies are needed to confirm these results.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; C-Reactive Protein; Cardiovascular Diseases; Creatinine; Cystatin C; Female; Humans; Inflammation; Inflammation Mediators; Kaplan-Meier Estimate; Kidney Diseases; Male; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Prospective Studies; Recurrence; Risk Assessment; Risk Factors; ROC Curve; Systole; Time Factors; Ventricular Dysfunction, Left

CXCL16/SR-PSOX is an interferon-gamma-regulated chemokine and scavenger receptor for oxidized low-density lipoprotein that is expressed in atherosclerotic lesions. Proteolytic cleavage of membrane-bound CXCL16 releases soluble CXCL16, which may promote migration of effector T cells and augment a proatherogenic inflammatory response. We hypothesized that soluble CXCL16 concentrations are associated with long-term outcome in patients with acute coronary syndromes.. We assessed the association between circulating CXCL16 levels obtained within 24 hours after admission and time to death in 1351 patients (median age 67 years, 30% female) with a diagnosis of unstable angina, non-ST-segment-elevation myocardial infarction, or ST-segment-elevation myocardial infarction. During a median follow-up time of 81 months, 377 patients died. Increased levels of CXCL16 were prognostically unfavorable; the fourth versus first quartile was associated with higher risk of death (hazard ratio 2.1; 95% CI 1.6 to 2.8; P<0.0001), triple risk of developing heart failure (hazard ratio 3.0; 95% CI 1.8 to 5.1; P<0.0001), and a doubling of the risk of rehospitalization for myocardial infarction (hazard ratio 2.1; 95% CI 1.3 to 3.3; P=0.002). After adjustment for conventional risk markers, logarithmically transformed CXCL16 level remained a strong independent indicator of long-term mortality (hazard ratio 1.21; 95% CI 1.09 to 1.36 per 1 SD increase in CXCL16; P=0.0006) and congestive heart failure development (hazard ratio 1.25; 95% CI 1.05 to 1.48; P=0.01). In a subsample of 714 patients, after further adjustment for troponin T, high-sensitive C-reactive protein, pro-B-type natriuretic peptide, and left ventricular ejection fraction, CXCL16 still provided significant additional prognostic information on mortality (hazard ratio 1.21; 95% CI 1.02 to 1.42 per 1 SD increase in CXCL16; P=0.02).. In patients with an acute coronary syndrome, CXCL16 levels obtained within 24 hours of admission are associated with long-term mortality after adjustment for other risk factors.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; C-Reactive Protein; Chemokine CXCL16; Chemokines, CXC; Female; Follow-Up Studies; Humans; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Patient Readmission; Prognosis; Proportional Hazards Models; Receptors, Scavenger; Risk Factors; Solubility; Troponin T

Elevated levels of B-type natriuretic peptide (BNP) are associated with adverse clinical outcomes in acute coronary syndrome (ACS), but several questions remain outstanding. Firstly, it has not yet been determined whether an additional BNP sample at 7 weeks post ACS would enhance risk prediction. Secondly, we assessed whether the prognostic potential of BNP in ACS could be explained by echocardiographic abnormalities such as left ventricular hypertrophy (LVH).. We measured bedside BNP levels in 443 consecutive patients presenting with ACS and at 7 weeks outpatient follow-up. Main outcome measure was either all-cause mortality, readmission with ACS, or congestive heart failure) at 10 months from presentation.. Of the 443 patients, 120 patients presented with ST-elevation myocardial infarction (27%). There were 90 cardiovascular (CV) events at 10 months. Adjusting for age, sex, hypertension, diabetes mellitus, smoking status, renal dysfunction, left ventricular ejection fraction, and echocardiographic LVH elevated near patient BNP levels (>80 pg/mL) were still associated with subsequent CV events when measured on admission (adjusted relative risk [RR] 2.63 [95% CI 1.34-5.19)] and also at 7 weeks post ACS (adjusted RR 4.12 [95% CI 1.58-10.72]). Patients with persistent BNP elevation at 7 weeks were also at an increased risk of CV events compared to those with an initial high BNP which then fell (unadjusted RR 4.04 [95% CI 1.24-13.15]).. In ACS, bedside BNP levels predict CV events at 10 months, independent of many echocardiographic abnormalities including LVH. Furthermore, our study suggests that an additional 7 weeks post ACS BNP enhances risk stratification over and above a one-off high BNP at baseline.

Topics: Acute Coronary Syndrome; Aged; Atrial Function, Left; Echocardiography; Female; Follow-Up Studies; Heart Failure; Humans; Hypertrophy, Left Ventricular; Kaplan-Meier Estimate; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Point-of-Care Systems; Predictive Value of Tests; Prognosis; Reference Values; Risk Factors; Ventricular Dysfunction, Left

The aim of the present study was to investigate the predictive value of MMP (matrix metalloproteinase)-2, MMP-3 and MMP-9 levels in patients with acute coronary syndrome for death, readmission with HF (heart failure) or recurrent MI (myocardial infarction) and to compare them with established markers, NT-proBNP (N-terminal pro-B-type natriuretic peptide) and the GRACE (Global Registry of Acute Coronary Events) score. A single blood test was taken 4 days after admission in 1024 consecutive patients with acute MI with end points observed over 519 (134-1059) days [value is median (range)]. MMP-2 and MMP-3 were increased in patients who died (n=111) compared with survivors (P<0.006 and P=0.01 respectively), but were similar in patients with HF (n=106) or MI (n=138). MMP-9 levels were similar across study end points. Using Cox proportional hazards modelling, MMP-2 demonstrated an independent prediction of death [HR (hazard ratio) 6.60, P=0.001], along with NT-proBNP (HR 4.62, P<0.001) and the GRACE score (HR 1.03, P<0.001), but MMP-3, MMP-9 or log10-troponin I did not. For 1 year mortality, the areas under the receiver operating characteristic curves were 0.60 and 0.58 for MMP-2 and MMP-3 respectively, compared with 0.82 for NT-proBNP and 0.84 for the GRACE score (all P<0.001). Kaplan-Meier analysis revealed that MMP-2 levels in the top quartile were associated with higher mortality rates (log rank 12.49, P=0.006). On univariate analysis, MMP-2 and MMP-3 had a weak association with HF readmission, which was lost after adjustment for clinical factors. None of the MMPs tested predicted MI. In conclusion, this is the first single centre study that identifies MMP2 as an independent predictor of all-cause mortality post-ACS (acute coronary syndrome); however, NT-proBNP and the GRACE score are superior for risk stratification in this cohort.

Topics: Acute Coronary Syndrome; Aged; Aged, 80 and over; Biomarkers; Clinical Enzyme Tests; England; Female; Heart Failure; Humans; Male; Matrix Metalloproteinase 2; Matrix Metalloproteinase 3; Matrix Metalloproteinase 9; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Patient Readmission; Peptide Fragments; Prognosis; Severity of Illness Index; Survival Analysis; Ultrasonography; Ventricular Dysfunction, Left

The aim of this study was to assess risk prediction by different biomarkers in patients with an ongoing non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and after clinical stabilization.. Different biomarkers reflect different aspects of the pathobiology in NSTE-ACS. However, there is little information regarding their relative prognostic value during the time course of disease.. The N-terminal pro-brain natriuretic peptide (NT-proBNP), C-reactive protein (CRP), cardiac troponin I (cTnI), and the estimated glomerular filtration rate (eGFR) were measured at randomization and after 6 weeks and 6 months in 877 NSTE-ACS patients included in the FRISC (FRagmin and fast revascularization during InStability in Coronary artery disease) II trial. The biomarkers' prognostic value during 5-year follow-up was evaluated by Cox regression models, calculation of the c-statistics, and estimation of the net reclassification improvement (NRI).. Among the biomarkers measured at randomization, NT-proBNP was the strongest predictor for mortality (adjusted hazard ratio [HR]: 1.7; 95% confidence interval [CI]: 1.3 to 2.1; p < 0.001). Even during follow-up, NT-proBNP demonstrated the strongest association to the composite end point of death/myocardial infarction (adjusted HR at 6 weeks: 1.5; 95% CI: 1.3 to 1.7; p < 0.001; adjusted HR at 6 months: 1.4; 95% CI: 1.2 to 1.7; p = 0.001). Even CRP was independently predictive at 6 months for the composite end point (adjusted HR: 1.3; 95% CI: 1.1 to 1.5; p = 0.003). Only 6-week results of NT-proBNP provided significant incremental prognostic value to established risk indicators regarding the composite end point (c-statistics 0.69 [p = 0.03]; NRI 0.11 [p = 0.03]).. The NT-proBNP is an independent risk predictor in patients with ongoing NSTE-ACS and after clinical stabilization. The CRP exhibits increasing predictive value at later measurements. However, only NT-proBNP provided incremental prognostic value and might therefore be considered as a complement for early follow-up controls after NSTE-ACS.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; C-Reactive Protein; Female; Glomerular Filtration Rate; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Risk Assessment; Risk Factors; Troponin I

Topics: Acute Coronary Syndrome; Aged, 80 and over; Biomarkers; Health Status Indicators; Humans; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests

The plasma B-type natriuretic peptide (BNP) level is elevated in cardiac ischemia and may be useful in assessing prognosis in acute coronary syndromes (ACS). This study aimed to: (1) establish BNP levels and its determinants in a healthy Gulf Arab population and in a group of patients with acute myocardial infarction and (2) investigate associations between BNP levels and markers of myocardial damage (ejection fractions, cardiac troponin I [cTnI] levels) and inflammation (serum C-reactive protein [CRP]).. We studied 2 groups of Arab subjects: (1) Healthy control (HC), 142 healthy control subjects; (2) Coronary heart disease (CHD), 257 patients with proven acute myocardial infarction within 1 day of admission. Each subject was assessed clinically, and ejection fractions (left ventricular ejection fraction [LVEF]) were determined by echocardiography in those with CHD. Fasting blood samples were processed for full blood counts and serum glucose, urea, creatinine, uric acid, and lipids (total cholesterol [TC], triglycerides [TG], high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein [LDL], and apolipoprotein B [apoB]), cTnI, BNP, and high-sensitivity (hs) CRP levels. The results were compared between groups, and the associations of BNP with other parameters were explored.. In comparison to HC, the CHD group had a greater waist-hip ratio (WHR) (P < 0.01), worse atherogenic profile, worse renal function, and higher values for CRP and BNP (all P < 0.001). There were no significant differences in values for BNP related to age, diabetes, hypertension, WHR, and hematocrit, although there was a consistent trend in both HC and CHD groups toward a negative relationship of BNP with body mass, TG, and apoB levels, and a positive relationship with HDL, independent only for HDL and apoB on multiple logistic regression. No correlations could be established with cTnI, CRP, and LVEF. The patterns of cross-correlations did not differ significantly with diabetic status.. In an Arab population with CHD, blood levels of BNP are higher than in a healthy control population and appear correlated to body mass and atherogenic lipids but not CRP, troponin, or ejection fraction. BNP levels did not appear to be influenced by the classical CHD risk factors of diabetes, hypertension, cigarette smoking, hematocrit, or WHR. The independent link with atherogenic dyslipidemia suggests that BNP is important in atherogenesis and may not be just an index of cardiac contractile dysfunction.

Topics: Acute Coronary Syndrome; Adult; Aged; Arabs; Atherosclerosis; Body Mass Index; Case-Control Studies; Dyslipidemias; Female; Humans; Kuwait; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Prognosis; Risk Factors

NT-proBNP has prognostic implications in heart failure. In acute coronary syndromes (ACS) setting, the prognostic significance of NT-proBNP is being sought. We studied short-term prognostic impact of admission NT-proBNP in patients admitted for ACS and in association with GRACE risk score (GRS).. We studied 1035 patients admitted with ACS. Patients were divided in quartiles according to NT-proBNP levels on admission: Q1 <180 pg/ml; Q2 180-691 pg/ml; Q3 696-2664 pg/ml; Q4 2698-35 000 pg/ml. Groups were compared in terms of short-term all-cause mortality. Patients with higher NT-proBNP had worst GRS on admission. They also received less aggressive treatment. In-hospital mortality was 0.8%, 3.0%, 5.8% and 12.8% (P<0.001) and 30-day mortality 1.6%, 4.6%, 6.5% and 16.7% (P<0.001) respectively. In multivariate logistic regression analysis, NT-proBNP is an independent predictor of in-hospital (OR 2.35; 95% CI: 1.12-4.93, P=0.022) and 30-day mortality (OR 2.20; 95% CI: 1.17-4.12, P=0.014). However, NT-proBNP does not add any incremental benefit to GRS for prediction of outcome by ROC curve analysis.. NT-proBNP is an independent predictor of in-hospital and 30-day mortality after ACS, independently of left ventricular function, but does not increase the prognostic accuracy of GRS.

Topics: Acute Coronary Syndrome; Analysis of Variance; Biomarkers; Chi-Square Distribution; Female; Hospital Mortality; Humans; Linear Models; Logistic Models; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Patient Admission; Peptide Fragments; Portugal; Predictive Value of Tests; Prognosis; Retrospective Studies; Risk Assessment; Risk Factors; ROC Curve; Severity of Illness Index; Statistics, Nonparametric; Ventricular Dysfunction, Left

The aim of this analysis was to assess the predictive value of activated factor XII type A (XIIaA) and B-type natriuretic peptide (BNP) in acute coronary syndrome patients stratified according to troponin release and to evaluate their complementary utility as predictors of all-cause mortality and recurrent troponin T (TnT)-positive events. Multivariable analysis in 870 patients admitted with suspected myocardial infarction was performed using the Cox proportional hazard ratio model. Variables in the model included XIIaA and BNP as well as conventional risk factors for mortality. Although both XIIaA and BNP were identified as independent predictors for all-cause mortality in the total group of patients, only BNP was found to be an independent predictor for all-cause mortality in patients with a confirmed myocardial infarction (TnT > 0.05 ng/ml) at admission (hazard ratio 4.24, 95% confidence interval 1.28-14.07), whereas only XIIaA was an independent predictor for all-cause mortality in patients with low TnT release (0.01 < TnT < or = 0.05 ng/ml) at admission (hazard ratio 10.37, 95% confidence interval 2.89-37.21). The combination of these two biomarkers provided complementary prognostic information for all-cause mortality as compared with each of the biomarkers alone in the total patient material. XIIaA is particularly useful in predicting mortality in acute coronary syndrome patients with low troponin release, whereas BNP is effective in predicting mortality in patients with confirmed myocardial infarction and more substantial troponin release. The combination of these two biomarkers improves outcome prediction in unselected patients with chest pain and acute coronary syndrome.

Topics: Acute Coronary Syndrome; Biomarkers; Factor XIIa; Mortality; Multivariate Analysis; Myocardial Infarction; Natriuretic Peptide, Brain; Predictive Value of Tests; Prospective Studies; Troponin T

The N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) is a sensitive indicator of hemodynamic stress and its increased level is associated with higher mortality in acute coronary syndrome (ACS) patients. Virtual histology-intravascular ultrasound (VH-IVUS) can provide quantitative information on plaque components.. We measured preprocedural serum NT-pro-BNP levels in 156 ACS patients with preserved left ventricular systolic function and normal serum creatinine. VH-IVUS classified the color-coded tissue into four major components: fibrotic, fibro-fatty, dense calcium, and necrotic core (NC). Thin-cap fibroatheroma (TCFA) was defined as focal, NC-rich (>or=10% of the cross-sectional area) plaques being in contact with the lumen in a plaque burden of at least 40%. We divided the patients into two groups according to the NT-pro-BNP levels [group I: >or=200 pg/ml (n = 58) vs. group II: <200 pg/ml (n = 98)].. The percent areas of NC at the minimum lumen site (19.8+/-13.1% vs. 15.2+/-11.1%, P = 0.027) and at the largest NC site (24.7+/-10.3% vs. 19.2+/-11.4%, P = 0.015) were significantly greater in group I than in group II. Percent NC volume was significantly greater in group I than in group II (15.8+/-8.1% vs. 10.1+/-9.1%, P = 0.008). The total number of TCFAs was 38 in group I and 56 in group II. The presence of at least one TCFA (58 vs. 38%, P = 0.009) and multiple TCFAs (25 vs. 10%, P = 0.005) within culprit lesions were observed more frequently in group I than in group II. The TCFAs were located more in proximal in group I than in group II [the length from coronary ostium to TCFA: 10.8+/-7.6 mm in group I vs. 25.7+/-16.3 mm in group II (P<0.001)]: 85% of TCFAs was located within 20 mm from coronary ostium in group I; conversely only 36% of TCFAs was located within 20 mm from coronary ostium in group II (P<0.001).. VH-IVUS analysis shows that ACS patients with high NT-pro-BNP levels had more vulnerable plaque component (more NC-containing lesions and higher frequency of culprit lesion TCFAs) and had more proximally located TCFAs.

Topics: Acute Coronary Syndrome; Aged; Angioplasty, Balloon, Coronary; Biomarkers; Calcinosis; Coronary Angiography; Coronary Artery Disease; Coronary Vessels; Creatinine; Female; Fibrosis; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Necrosis; Peptide Fragments; Predictive Value of Tests; Retrospective Studies; Ultrasonography, Interventional; Up-Regulation; Ventricular Function, Left

Advances in technologies for immunoassay testing have enabled the development of 15-minute whole-blood assays for cardiac markers in the evaluation of patients with acute coronary syndromes (ACS) and congestive heart failure. In many cases, the analytical performance of these assays is equivalent to that of testing in the central laboratory. Rapid whole-blood point-of-care assays for troponin, creatine kinase isoenzyme CK-MB, myoglobin, and B-type natriuretic peptides have facilitated efforts to restructure conventional approaches to ACS and heart failure in the emergency room. Improvements in outcomes, including decreased emergency room and hospital length-of-stay, decreased overall cost, and earlier discharge of low-risk patients, have been documented following implementation of these technologies.

Topics: Acute Coronary Syndrome; Biomarkers; Creatine Kinase; Creatine Kinase, MB Form; Diagnosis, Differential; Heart Failure; Humans; Immunoassay; Myocardial Infarction; Natriuretic Peptide, Brain; Point-of-Care Systems; Troponin

To compare the prognostic value of B-type natriuretic peptide (BNP) and GRACE score in patients with acute coronary syndrome.. A total of 246 patients with chest pain to hospital time < 24 hours were followed up to 30 days. Admission plasma B-type natriuretic peptide was measured by point-of-care. Endpoints included death, reinfarction, recurrent ischemia and new onset of congestive heart failure. The receiver operating characteristic (ROC) curve was used to evaluate prognostic value of BNP and GRACE score. The logistic regression models were used to assess the prognostic contribution of BNP level and GRACE score.. The mean age was (67.6 +/- 12.0) years (61.8% males) and ST elevation myocardial infarction (STEMI) was diagnosed in 135 patients (54.9%). During the follow up, 34 endpoints (13.8%) were recorded including 9 deaths (3.7%). The systolic blood pressure [(121 +/- 29) mm Hg vs. (130 +/- 23) mm Hg, P = 0.034; 1 mm Hg = 0.133 kPa] was significantly lower while the heart rate and plasma creatinine were significantly higher in the endpoints group than in non-endpoints group. TNI and CRP levels were similar between the two groups. The BNP level at admission (median 883.5 ng/L vs. 216.5 ng/L) and GRACE score (median 164.5 vs. 142.0) were significantly higher in the endpoints group than in non-endpoints group (all P < 0.05). The prognostic criteria for BNP level (area under cure, 0.704) was 194.5 ng/L determined by ROC (P = 0.043). For GRACE score, the predictive value for endpoints was 0.742 (P = 0.003) and the cut-off point was 158. In the logistic regression model, BNP concentration (> 194.5 ng/L, OR = 3.174) and GRACE score (> 158, OR = 4.031) were independent predictors of endpoints in patients with ACS.. Both BNP level at admission and GRACE score were independent predictors for endpoints at 30 days in patients with ACS.

Topics: Acute Coronary Syndrome; Adult; Aged; Aged, 80 and over; Female; Humans; Logistic Models; Male; Middle Aged; Natriuretic Peptide, Brain; Prognosis; Risk Assessment; ROC Curve

Topics: Acute Coronary Syndrome; Biomarkers; Coronary Artery Disease; Growth Differentiation Factor 15; Humans; Natriuretic Peptide, Brain; Prognosis; Risk Factors; Troponin

Topics: Acute Coronary Syndrome; Biomarkers; Humans; Natriuretic Peptide, Brain; Nerve Tissue Proteins; Peptide Fragments; Protein Precursors

Topics: Acute Coronary Syndrome; Biomarkers; Evidence-Based Medicine; Humans; Hyperglycemia; Hypoglycemic Agents; Insulin; Natriuretic Peptide, Brain; Peptide Fragments; Randomized Controlled Trials as Topic; Stroke Volume; Time Factors; Tomography, Emission-Computed, Single-Photon; Treatment Outcome; Troponin T; Ventricular Function, Left

Early diagnosis of acute coronary syndromes (ACS) allows for efficient risk stratification, appropriate targeted therapies, and faster patient disposition within crowded emergency departments. Although only troponin testing is recommended for routine use in the 2007 American College of Cardiology/American Heart Association guidelines for non-ST-elevation ACS, emerging data support selected use of other biomarkers, including B-type natriuretic peptides (BNPs) and C-reactive protein. There remains a need to identify additional biomarkers in ACS to enhance risk stratification and to help guide therapeutic decisions in this increasingly complex area of cardiovascular medicine. Cardiac biomarkers may help to diagnosis ACS before cardiomyocyte necrosis, to influence the decision for early invasive treatment, and to provide a means of monitoring response to therapy. In this review, we assess new data in ACS with respect to troponins, BNPs, myeloperoxidase, fatty acid-binding protein, and monocyte chemoattractant protein-1. We also discuss novel biomarkers including growth deficient factor-15 and neopterin.

Topics: Acute Coronary Syndrome; Biomarkers; C-Reactive Protein; Early Diagnosis; Humans; Natriuretic Peptide, Brain; Risk Assessment; Risk Factors; Troponin

STUDY AIM - assessment of dynamics of markers of inflammation (CRP, Il-6, Il-10, TNFa, CD40L, fibrinogen) and N - N in acute coronary syndrome (ACS) as well as analysis of effect of various methods of treatment on level of these parameters. Patient aged 30 - 70 years were included in the study: 52 patients with ACS with ST-segment elevation (STEACS) and 61 - without ST-segment elevation (NSTEACS). Initial level of markers of inflammation (Il-6, CRP) in STEACS was lower than in NSTEACS. Initial level of antiinflammatory Il-10 was significantly higher in patients in the STEACS group (72.6 +/- 39.1 and 6.6+4.2 pg/ml, < 0.01). At admission the highest values of N - N were noted in the group of NSTEACS (761.5 pg/ml compared with 451.1 pg/ml in STEACS, =0.04). During period of hospitalization elevation of N - N occurred in the group of STEACS while its lowering occurred in the group of NSTEACS. In STEACS patients with early restored coronary blood flow dysfunction of the myocardium was less pronounced (lower level of N - N ). In patients with NSTEACS during period of hospitalization levels of CRP, Il-6 fibrinogen lowered. In invasively treated patients with NSTEACS levels of CRP and fibrinogen lowered to a greater extent than in conservatively treated.

Topics: Acute Coronary Syndrome; Adult; Aged; C-Reactive Protein; CD40 Ligand; Cytokines; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Tumor Necrosis Factor-alpha

Few studies have addressed whether the combined use of B-type natriuretic peptide (BNP) and high-sensitive C-reactive protein (hsCRP) improves risk stratification for mortality and cardiovascular events in a population with chest pain and suspected acute coronary syndromes (ACS). Therefore, we wanted to assess the incremental prognostic value of these biomarkers with respect to long-term all-cause mortality and recurrent troponin T (TnT) positive cardiac events in 871 patients admitted to the emergency department.. Blood samples were obtained immediately following admission.. After a follow-up period of 24 months, 129 patients had died. The BNP levels were significantly higher among patients dying than in long-term survivors (401 (145-736) versus 75 (29-235) pq/mL [median, 25 and 75% percentiles], p = 0.000). In a multivariable Cox regression model for death within 2 years, the hazard ratio (HR) for BNP in the highest quartile (Q4) was 5.13 (95% confidence interval (CI), 1.97-13.38) compared to the lowest quartile (Q1) and was associated with all-cause mortality above and beyond age, congestive heart failure and the index diagnosis ST-segment elevation myocardial infarction. HsCRP rendered no prognostic information for all-cause mortality. However, within 30 days, the adjusted HR for patients with recurrent TnT cardiac positive events hsCRP in Q4 was 14.79 (95% CI, 1.89-115.63) compared with Q1 and was associated with recurrent ischemic events above and beyond age, hypercholesterolemia and TnT values at admission.. BNP may act as a clinically useful biomarker when obtained at admission in an unselected patient population following hospitalization with chest pain and potential ACS, and may provide complementary prognostic information to established risk determinants at long-term follow-up. Our data do not support the hypothesis that the additional assessment of hsCRP will lead to better risk stratification for survival than BNP alone.

Topics: Acute Coronary Syndrome; Adult; Aged; Aged, 80 and over; Biomarkers; C-Reactive Protein; Chest Pain; Female; Follow-Up Studies; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Prognosis; Risk Factors; Secondary Prevention; Survival Analysis; Time Factors; Troponin T

Topics: Acute Coronary Syndrome; Atrial Natriuretic Factor; Biomarkers; Humans; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Risk Assessment; Risk Factors

To determine if elevations of adhesion molecules in acute coronary syndrome (ACS) are useful for risk stratification.. A cell adhesion array (Randox Ltd.) and NT-proBNP were measured in 216 ACS patients.. Kaplan-Meier and Cox models indicate early elevations of NT-proBNP but not the adhesion molecules are predictive of future death/myocardial infarction.. Elevations of adhesion molecules early after pain onset in ACS are not useful for long-term risk stratification.

Topics: Acute Coronary Syndrome; Biomarkers; Cell Adhesion Molecules; Humans; Kaplan-Meier Estimate; Microarray Analysis; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Proportional Hazards Models; Protein Precursors; Risk Factors; Troponin T

To analyse osteoprotegerin (OPG), and B-type natriuretic peptide (BNP) levels in patients with non-ST elevation acute coronary syndrome (NSTE-ACS), in relation to clinical presentation and to coronary atherosclerosis diffusion. OPG has been found in several tissues, including the cardiovascular system, BNP is selectively produced by myocardial cells.. 178 consecutive patients were classified in three groups: stable angina (SA), unstable angina/non-ST elevation myocardial infarction (NSTE-ACS) and control group, measuring OPG and BNP at hospital admission. We compared both biomarkers in relation to the number of coronary narrowed vessels (1-, 2- , 3- or 4- vessels disease), and to the stenoses degree by Duke Jeopardy score.. OPG levels were higher in patients respect to controls (p<0.0001). Patients with SA showed more elevated levels than controls (2.6+/-1.2 vs 7.4+/-5.0 pmol/l p<0.01). However patients with NSTE-ACS had higher OPG level with respect to SA patients (11.8+/-7.1 pmol/l p<0.001). A positive relation was found between OPG levels and number of coronary plaques by Duke Jeopardy score (r=0.65). BNP levels were higher in patients with NSTE-ACS respect to controls and SA patients (p<0.001). Besides, BNP was significantly higher in multivessels vs 1-vessel disease (p<0.001).. Patients with NSTE-ACS show high OPG levels. OPG increase seems related to the number of plaques in the coronary vessels, suggesting its involvement in the coronary disease progression. BNP is also increased during NSTE-ACS and more associated to coronary narrowing.

Topics: Acute Coronary Syndrome; Aged; Angina Pectoris; Coronary Angiography; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Osteoprotegerin

The purpose of this study was to determine the prognostic value of N-terminal B-type natriuretic peptide (NT-proBNP) in two independent samples of patients presenting with acute coronary syndromes (ACS) and normal troponin T (TnT) values.. Recently assessment of NT-proBNP has been studied in patients with ACS. However, the clinical relevance in patients who present without troponin elevation is unclear.. We included 2,614 patients from two independent registries, one serving as a derivation cohort comprising patients with evident ACS (Bad Nauheim ACS registry, n = 1,131) and the other serving as a validation cohort including chest pain patients (PACS [Prognosis in Acute Coronary Syndromes] registry, n = 1,483). NT-proBNP and TnT were measured upon admission. Clinical outcome has been assessed over a 6-month period.. In both cohorts, the mortality rate was significantly lower among TnT negative patients: 3.8% versus 8.2% (p = 0.009) in the Bad Nauheim ACS registry, and 2.8% versus 8.6% (p = 0.009) in the PACS registry. Among TnT negative patients, receiver-operating characteristics curve analysis yielded an optimal cutoff value of 474 pg/ml for NT-proBNP that was able to discriminate patients at higher risk in the Bad Nauheim ACS and PACS registries (mortality rate 12.3% vs. 1.3%, p < 0.001 and 8.5% vs. 1.5%, p < 0.001, respectively). By Kaplan-Meier analysis, patients with NT-proBNP values over 474 pg/ml were at higher risk for death in the Bad Nauheim ACS registry (log-rank 19.01, p < 0.001, adjusted hazard ratio [HR] 9.56 [95% confidence interval (CI) 2.42 to 37.7], p = 0.001) and in the PACS registry (log-rank 23.16, p < 0.001, adjusted HR 5.02 [95% CI 2.04 to 12.33], p < 0.001).. Among patients with suspected ACS considered to be at low risk because of normal troponin values, NT-proBNP above 474 pg/ml is able to discriminate individuals at higher risk. Because of its incremental prognostic value, NT-proBNP assessment should be considered in clinical routine for risk stratification of patients with normal troponin.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Cohort Studies; Electrocardiography; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Risk Assessment; Sensitivity and Specificity; Troponin T

Guidelines for treatment of acute coronary syndrome (ACS) recommend observing a rise or fall in cardiac troponin (cTn) concentrations for assessing acute injury. It is unknown whether a rising pattern presages a more adverse long-term prognosis than elevations that do not change. The present study assessed whether a rising pattern of cardiac biomarkers was more prognostic than simple elevations.. We measured N-terminal pro-brain natriuretic peptide (NT-proBNP) (Roche), cTnT (Roche) and cTnI (Beckman Coulter) in 212 ACS patients. These biomarkers were measured in coincident EDTA and heparin plasma samples available from at least 2 different time points, an early first specimen obtained a median of 2 hours after onset of symptoms, interquartile range (IQR) 2-4 hours, and a later second specimen obtained at 9 hours, IQR 9-9 hours. The cTn concentration in the second specimen was used to classify myocardial necrosis (cTnI >0.04 ug/L; cTnT >0.01 ug/L). Outcomes [death, myocardial infarction (MI), heart failure (HF)] were obtained >8 years after the initial presentation. For patients with myocardial necrosis and a cTn concentration ratio (second/first measured concentrations) > or =1.00, the concentration ratios and the absolute concentrations in the second specimen were used to assess prognosis after 4 years.. In myocardial necrosis, the relative change (cTn2/cTn1) was greater for cTnI than for cTnT (P <0.01), whereas the relative change in NT-proBNP was the same regardless of which troponin was used to classify necrosis (P = 0.71). The concentration ratio for cTnI, cTnT, and NT-proBNP was not useful for risk stratification (i.e., death/MI/HF; P > or =0.15).. A rise in cardiac troponin or NT-proBNP concentration in ACS patients presenting early after onset of pain is not helpful for long-term prognosis.

Topics: Acute Coronary Syndrome; Biomarkers; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Protein Precursors; Risk Assessment; Time Factors; Troponin I; Troponin T

Hypertension is associated with high cardiovascular risk. Both hsCRP and NT-proBNP also have been associated with elevated cardiovascular risk, at least in the long term. Much less is known about the short-term changes in these markers, for example, in hypertensive emergencies. In 59 consecutive patients with hypertensive emergencies, hsCRP and NT-proBNP were measured at baseline and at days 3-4 and 7-10 after admission. All patients with hsCRP levels above 10 mg/l during the study were excluded due to possible infections. We found elevated levels of hsCRP at baseline with a significant decline on days 3-4 (day 0: median 2.53 mg/l, days 3-4: median 1.65 mg/l [p<0.01 vs. baseline], days 7-10 median: 2.00 mg/l). Women had higher hsCRP levels than men, and patients with hypertensive cardiomyopathy by echocardiographic criteria had significantly higher hsCRP levels compared with patients without hypertensive cardiomyopathy throughout the study. NT-proBNP levels were clearly elevated at admission (median 158 ng/l) and declined highly significantly thereafter (day 3-4: 61 ng/l, p<0.0001 vs. baseline; day 7-10: 76 ng/l, p<0.0001 vs. baseline). Patients with hypertensive cardiomyopathy had higher NT-proBNP levels compared with those patients without. In hypertensive emergencies, NT-proBNP levels correspond to levels described in acute coronary syndrome and decline significantly under antihypertensive therapy. In addition, we found an acute decline in hsCRP in the short term after hypertensive emergencies. These data may have importance in the clinical setting of hypertensive emergencies and in the interpretation of epidemiological data.

Topics: Acute Coronary Syndrome; Aged; Blood Pressure; Body Mass Index; C-Reactive Protein; Cardiomyopathies; Echocardiography; Emergencies; Female; Humans; Hypertension; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments

In acute coronary syndromes, risk stratification is essential, particularly in those without ST-elevation, and is based upon clinical and biological markers. Among them, recent and repeated anginal attacks, ST-segment modifications on admission electrocardiogram, and increased markers of myonecrosis (particularly increased troponine levels) are strong predictors of untoward outcome. These variables can be used to construct risk scores, among which the TIMI and GRACE scores are the most widely used. These scores may prove helpful to define the optimal diagnostic and therapeutic management of the patients.

Topics: Acute Coronary Syndrome; C-Reactive Protein; Electrocardiography; Humans; Natriuretic Peptide, Brain; Prognosis; Risk Assessment

Inflammation in acute coronary syndrome (ACS) can identify those at greater long-term risks for heart failure (HF) and death. The present study assessed the performance of interleukin (IL)-6, IL-8, and monocyte chemoattractant protein-1 (MCP-1) (cytokines involved in the activation and recruitment of leukocytes) in addition to known biomarkers [e.g., N-terminal pro-brain natriuretic peptide (NT-proBNP)] for predicting HF and death in an ACS population.. In a cohort of 216 ACS patients, NT-proBNP (Elecsys; Roche) and IL-6, IL-8, and MCP-1 (evidence investigator; Randox) were measured in serial specimens collected early after symptom onset (n = 723). We collected at least 2 specimens from each participant: an early specimen (median 2 h; interquartile range 2-4 h) and a later specimen (9 h; 9-9 h), and used the later specimens' biomarker concentrations for risk stratification.. An increase in both IL-6 and NT-proBNP was observed but not for IL-8 or MCP-1 early after pain onset. Kaplan-Meier analysis demonstrated that individuals with increased NT-proBNP (>183 ng/L) or cytokines (IL-6 > 6.4 ng/L; above upper limit of normal for IL-8 or MCP-1) had a greater probability of death or HF in the following 8 years (P <0.05). In a Cox proportional hazard model adjusted for both CRP and troponin I, increased IL-6, MCP-1, and NT-proBNP remained significant risk factors. Combining all 3 biomarkers resulted in a higher likelihood ratio for death or HF than models restricted to any 2 of these biomarkers.. IL-6, MCP-1, and NT-proBNP are independent predictors of long-term risk of death or HF, highlighting the importance of identifying leukocyte activation and recruitment in ACS patients.

Topics: Acute Coronary Syndrome; Aged; Chemokine CCL2; Female; Heart Failure; Humans; Inflammation; Interleukin-6; Interleukin-8; Leukocytes; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Retrospective Studies; Risk Factors

Biomarkers have emerged as interesting predictors of risk in non-ST elevation acute coronary syndromes (non-ST ACS). The aim of this study was to define the utility of the combined measurement of troponin T (TnT), C-reactive protein (CRP), NT pro-brain natriuretic peptide (NT pro-BNP) and D-dimer as biomarkers to predict adverse events.. We included 358 consecutive patients admitted in two hospitals for non-ST ACS. Baseline measurements of TnT (associated with myocardial injury, positive, if > or =0.1 ng mL(-1)), CRP (a marker of inflammation), NT-proBNP (associated with left ventricular (dys)function) and fibrin D-dimer (and index of thrombogenesis) were performed. A positive CRP, NT-proBNP and D-dimer test was considered upper than the 75th percentile of our population. The risk for major events (death, new ACS, revascularization and heart failure) at 6 months' follow-up was analysed.. Troponin T, NT pro-BNP and CRP were predictors of adverse events in the multivariate analysis [hazards ratio (HR): 2.00 (1.30-3.07), P = 0.0016; HR: 2.27 (1.47-3.50), P = 0.0002; HR: 1.90 (1.24-2.92), P = 0.0034 respectively], but not D-dimer levels [HR: 1.26 (0.79-2.02), P = 0.337). After adjusting for baseline characteristics and electrocardiographic changes, multimarker risk approach was associated with adverse events at 6 months, especially with the presence of three positive biomarkers [HR 2.80 (95%CI 1.68-4.68), P < 0.001]. When we divided patients by risk groups [Thrombolysis in Myocardial Infarction (TIMI) risk score], patients with two or three elevated biomarkers had higher event rates [HR 2.59 (95% CI 1.37-4.91), P = 0.004].. A multimarker approach based on TnT, CRP and NT-proBNP provides added information to the TIMI risk score in terms of ACS prognosis at 6 months, with a worse outcome for those with two or three elevated biomarkers.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; C-Reactive Protein; Female; Fibrin Fibrinogen Degradation Products; Follow-Up Studies; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Proportional Hazards Models; Risk Assessment; Troponin T

N-terminal pro-brain natriuretic peptide (Nt-proBNP) is a strong independent predictor of death in acute coronary syndromes. In order to improve risk assessment in patients with unstable coronary artery disease we investigated the role of the additional determination of Nt-proBNP levels in patients sub-grouped into high-, medium- and low-risk groups according to the TIMI risk score.. Nt-proBNP was determined in 145 consecutive patients admitted to our clinic with typical anginal pain in the past 24 hours and normal left ventricular function. Using classification and regression tree analysis, we investigated whether Nt-proBNP levels provide clinically relevant prognostic information in addition to the TIMI risk score. Nt-proBNP concentrations were determined using a commercially available assay from Biomedica, Austria. The normal range of this assay is <2827 pg/ml.. Multivariate logistic regression analysis revealed that TIMI scores and Nt-proBNP levels are independent predictors of mortality (P = 0.001 and P < 0.001, respectively). Patients with Nt-proBNP levels >5225 pg/ml had the highest mortality rate, independent of their TIMI risk classification. In the subset of patients with Nt-proBNP < or =5225 pg/ml, patients at TIMI medium risk but with Nt-proBNP above 2827 pg/ml had significantly higher mortality than patients with lower levels of Nt-proBNP (P = 0.03). Accordingly, we developed a combined risk score consisting of four risk groups: very high (Nt-proBNP > or =5225 pg/ml), high (TIMI high-risk group or TIMI medium-risk group and Nt-proBNP >2827 pg/ml), medium (TIMI medium-risk group and Nt-proBNP < or =2827 pg/ml) and low (TIMI low-risk group). The area under the receiver operating characteristic curve was 0.772 for the TIMI score alone and 0.863 for the combined risk score (P < 0.001).. Determination of plasma Nt-proBNP levels and incorporation of these into TIMI risk classification by creating a combined risk score significantly improves risk assessment of patients with unstable coronary artery disease.

Topics: Acute Coronary Syndrome; Aged; Austria; Biomarkers; Diagnosis, Computer-Assisted; Female; Humans; Incidence; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Proportional Hazards Models; Reproducibility of Results; Risk Assessment; Risk Factors; Sensitivity and Specificity; Survival Analysis; Survival Rate

Elevated B-type natriuretic peptide (BNP) levels are associated with increased risk for mortality in patients with non-ST-segment-elevation (NSTE) acute coronary syndromes (ACS). However, the optimal use of BNP measurement for the risk stratification of these patients remains unclear. This study was conducted to analyze patterns of, and factors associated with, BNP measurement in patients with NSTE ACS from the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines? (CRUSADE) quality improvement initiative from 2003 through 2006. The association of degree of BNP elevation with in-hospital mortality in patients with measured BNP levels across risk categories was also analyzed. A total of 16,323 of 77,071 patients (21.2%) from 486 hospitals had BNP levels measured; the rate of BNP measurement by quarter increased from 5.1% to 27.7% during this analysis. Factors most strongly associated with BNP measurement included signs of heart failure on presentation, older age, previous heart failure, faster presenting heart rate, and higher body mass index. The adjusted risk for mortality was higher in patients who had BNP levels measured than in those who did not (adjusted odds ratio 1.14, 95% confidence interval 1.03 to 1.25). In patients with BNP levels measured, a higher degree of BNP elevation was associated with incrementally higher in-hospital mortality rates across risk categories. BNP levels were measured in approximately 1/5 of patients with NSTE ACS in contemporary practice. BNP was most frequently measured in patients presenting with high-risk characteristics, but the association of incremental increases in BNP levels with higher mortality rates was similar across risk categories. In conclusion, more widespread measurement of BNP levels for risk stratification of patients with NSTE ACS may be warranted.

Topics: Acute Coronary Syndrome; Aged; Aged, 80 and over; Female; Hospital Mortality; Humans; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Retrospective Studies; Risk Assessment

To evaluate the prognostic value of plasma brain natriuretic peptide (BNP) and C-reactive protein (CRP) in patients with acute coronary syndromes (ACS) underwent percutaneous coronary intervention (PCI).. Patients with ACS underwent PCI in our hospital from December 2004 to September 2005 were included in this study. Plasma BNP (n = 189) and CRP (n = 141) were measured at a median of (34.2 +/- 16.3) hours from symptom onset, total mortality and the risk for major adverse cardiac events (MACE, including death, recurrent MI, recurrent angina, heart failure, readmission for any reason) at 30 days and at 3 months was analyzed.. Patients were divided into 4 groups according to their BNP levels (BNP 100 ng/L to 300 ng/L to 600 ng/L) and the 3-month mortality was 0%, 1.4%, 7.7%, 48.3% and 3-month incidence of MACE was 7.9%, 17.1%, 57.7%, 79.3% respectively. Multivariate logistic regression analyses showed that the plasma BNP level predicted 30-day (r = 0.8515, P < 0.01) and 3-month (r = 0.9201, P < 0.01) mortality and 30-day (r = 0.7066, P < 0.01) and 3-month (r = 0.7090, P < 0.01) incidence of MACE independent of other known prognostic factors such as age, gender, family heredity, hypercholesterolemia diabetes, hypertension, smoking and LVEF. Patients were divided into 3 groups according to their CRP levels (CRP 8.0 mg/L to 32.0 mg/L) and 3-month mortality was 2.7%, 7.7% and 28.6% and 3-month incidence of MACE was 28.4%, 41.0% and 60.7% respectively. CRP predicted 30-day (r = 0.5882, P = 0.0044) and 3-month (r = 0.5235, P = 0.0038) mortality independent of traditional risk factors, and predicted 30-day (r = 0.2705, P = 0.0380) and 3-month (r = 0.2290, P = 0.0429) incidence of MACE after adjustment for patient age. CRP lost its predictive value after BNP was introduced into the model, while BNP was still an independent predictor for mortality and incidence of MACE at 30 days and 3 months in ACS patients underwent PCI.. Both plasma BNP and CRP are good predictors for early mortality and MACE incidence in ACS patients underwent PCI.

Topics: Acute Coronary Syndrome; Adult; Aged; Aged, 80 and over; Angioplasty, Balloon, Coronary; C-Reactive Protein; Female; Follow-Up Studies; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Prognosis

To elucidate whether the plasma concentration of NT-proBNP in patients with acute coronary syndrome (ACS) correlated with severity of the diseases and whether NT-proBNP is a reliable biochemical marker correctly indicates the severity of ACS.. Eighty-nine subjects came from CCU of Cardiology Department of People's Hospital Beijing University from October 2003 to June 2004 and aged 34-85 y (66.89 +/- 11.12 y). In this study the spectrum of ACS only included unstable angina pectoris (UA) and acute myocardial infarction (AMI). Patients with UA were separated into 3 groups by Braunwald classes and those with AMI were separated into 4 groups by Killip classes when their venous blood samples were collected. Plasma concentration of NT-proBNP was measured by enzyme linked immunoabsorbent assay. Data was estimated by SPSS.. The concentration of NT-proBNP in patients with ACS was dramatically correlative with the severity of the diseases: with the upgrading of Braunwald classes, the concentration of NT-proBNP in patients with UA increased gradually; in patients with AMI it also raised gradually with the upgrading of killip classes; furthermore, the plasma concentration of NT-proBNP in patients with AIM increased much more than that in patients with UA when they are at the similar NYHA functional class.. Plasma concentration of NT-proBNP in patients with ACS might be a reliable biochemical marker which can objectively indicate the degree of this diseases.

Topics: Acute Coronary Syndrome; Adult; Aged; Aged, 80 and over; Humans; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments