Usefulness of Biomarker Strategy to Improve GRACE Score's Prediction Performance in Patients With Non–ST-Segment Elevation Acute Coronary Syndrome and Low Event Rates
We sought to assess whether multiple biomarkers would correlate with the outcome and could improve event prediction in non–ST-segment elevation acute coronary syndrome populations with low event rates. Nine inflammatory, ischemic, or neurohormonal biomarkers were measured within 48 hours after symptom onset in 440 patients with non–ST-segment elevation acute coronary syndrome from the ARCHIPELAGO (Irbesartan in Patients With Acute Coronary Syndrome Without ST Segment Elevation) trial. We assessed the relation between biomarkers and ischemic or heart failure composite end points at 2 months of follow-up. We also evaluated whether biomarkers could improve the predictive performance of the validated and well-performing Global Registry of Acute Coronary Events risk score. Among all biomarkers measured at baseline, only interleukin-6 correlated with the ischemic end point (adjusted odds ratio 1.69, 95% confidence interval [CI] 1.23 to 2.31). The independent correlates of the heart failure end point were B-type natriuretic peptide (adjusted odds ratio 3.16, 95% CI 1.99 to 5.03), aldosterone (adjusted odds ratio 1.57, 95% CI 1.14 to 2.16) and matrix metalloproteinase-9 (adjusted odds ratio 0.64, 95% CI 0.46 to 0.88). The Global Registry of Acute Coronary Events score predicted poorly the ischemic end point (area under the curve [AUC] 0.591) and fairly (AUC 0.775) the heart failure end point. The performance of the models was significantly improved by the introduction of interleukin-6 (AUC 0.685) for the ischemic end point and of the 3 biomarkers (AUC 0.874) for the heart failure end point. In conclusion, the interleukin-6 level only, and B-type natriuretic peptide, aldosterone, and matrix metalloproteinase-9 together, independently correlated with the ischemic and heart failure end points, respectively. The Global Registry of Acute Coronary Events risk score's performance was significantly improved with a biomarker strategy. In low-risk populations, a strategy using these biomarkers might help in identifying patients at greater risk of additional events.
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The Irbesartan in Patients With Acute Coronary Syndrome Without ST Segment Elevation (ARCHIPELAGO) trial was entirely funded by Sanofi-Aventis, Paris, France.
Dr. Beygui has received lecture fees from Sanofi-Aventis, Paris, France, Pfizer, New York, New York, and Astellas, Tokyo, Japan. Dr. Silvain has received research grants from Daiichi-Sankyo, Tokyo, Japan, Eli Lilly, Indianapolis, Indiana, and Sanofi-Aventis, Paris, France. Dr. Collet has received research grants from Bristol-Myers Squibb, Markham, Canada, Sanofi-Aventis, Paris, France, Eli Lilly, Indianapolis, Indiana, Guerbet Medical, Villepinte, France, Medtronic, Minneapolis, Minnesota, Boston Scientific, Natick, Michigan, Cordis, Bridgewater, New Jersey, Stago, Asnières sur seine, France, and Centocor, Ridgeview, Pennsylvania; consulting fees from Sanofi-Aventis, Paris, France, Eli Lilly, Indianapolis, Indiana, and Bristol-Myers Squibb, Markham, Canada; and lecture fees from Bristol-Myers Squibb, Markham, Canada, Sanofi-Aventis, Paris, France, and Eli Lilly, Indianapolis, Indiana. Dr. Montalescot has received research grants from BMS, Sanofi-Aventis, Paris, France, Eli Lilly, Indianapolis, Indiana, Guerbet Medical, Villepinte, France, Medtronic, Minneapolis, Minnesota, Boston Scientific, Natick, Michigan, Cordis, Bridgewater, New Jersey, Stago, Asnières sur seine, France, Centocor, Ridgeview, Pennsylvania, ITC Edison, Novi, Michigan, and Pfizer, New York, New York, and consulting fees from Sanofi-Aventis, Paris, France, Eli Lilly, Indianapolis, Indiana, BMS, The Medicines Company, Parcipanny, New Jersey, Schering-Plough, Kenilworth, New Jersey, Portola, S San Francisco, California, Novartis, Basle, Switzerland, Menarini, Florence, Italy, Eisai, Woodcliff lake, New Jersey, Daiichi, Bayer, Leverkusen, Germany, and Boehringer Ingelheim, Ingelheim am Rhein, Germany; and lecture fees from Sanofi-Aventis, Paris, France, Eli Lilly, Indianapolis, Indiana, BMS, Merck Sharpe and Dohme, Whitehouse station, New Jersey, Cordis, Bridgewater, New Jersey, GlaxoSmithKline, London, United Kingdom, Schering-Plough, Kenilworth, New Jersey, Accumetrics, San Diego, California, AstraZeneca, Wilmington, Delaware, Daiichi, and Menarini, Florence, Italy. Dr. Vicaut has received consulting fees from Pfizer, New York, New York.
PII: S0002-9149(10)00955-0
doi:10.1016/j.amjcard.2010.04.019
© 2010 Elsevier Inc. All rights reserved.
