LeLeiko Rebecca M, Vaccari Christopher S, Sola Srikanth, Merchant Nadya, Nagamia Sameer H, Thoenes Martin, Khan Bobby V
Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.
Am J Cardiol. 2009 Sep 1;104(5):638-43. doi: 10.1016/j.amjcard.2009.04.047. Epub 2009 Jun 24.
Our objectives were to evaluate the prognostic value of several biomarkers in patients with acute coronary syndrome (ACS) through an evaluation of the 30-day clinical outcomes. Multiple biomarkers have emerged as potentially useful in risk stratification of ACS. Specifically, markers of vascular inflammation and oxidative stress might be helpful in the determination of clinical outcomes. We evaluated patients presenting with chest pain. ACS was defined by symptoms of cardiac ischemia plus electrocardiographic changes or positive troponin I. Levels of serum troponin I, high sensitivity C-reactive protein, serum choline, and free F(2)-isoprostane were obtained. Patients were followed up for 30 days (n = 108) with determination of nonfatal myocardial infarction, congestive heart failure, need for revascularization, and death. Of the 108 patients, 26 had a cardiac event. Free F(2)-isoprostane and choline levels (but not high-sensitivity C-reactive protein levels) predicted 30-day cardiac events. To determine the value of choline and F(2)-isoprostane levels in predicting 30-day cardiac events, receiver operating curves were generated. The optimal cutoff point of these markers was a serum F(2)-isoprostane level of 124.5 pg/ml (r = 0.82) and a serum choline level of 30.5 mumol/L (r = 0.76). F(2)-isoprostane and choline had a positive predictive value of 57% and 44% and a negative predictive value of 90% and 89%, respectively. In conclusion, serum choline and free F(2)-isoprostane are predictors of cardiac events in ACS. A model that includes an array of biomarkers, including troponin, choline, and free F(2)-isoprostane, might be useful in predicting patients at greater risk of future events in ACS.
我们的目标是通过评估30天临床结局来评价几种生物标志物在急性冠状动脉综合征（ACS）患者中的预后价值。多种生物标志物已成为ACS风险分层中潜在有用的指标。具体而言，血管炎症和氧化应激标志物可能有助于确定临床结局。我们评估了出现胸痛的患者。ACS由心脏缺血症状加心电图改变或肌钙蛋白I阳性定义。测定血清肌钙蛋白I、高敏C反应蛋白、血清胆碱和游离F(2)-异前列腺素水平。对患者进行30天随访（n = 108），确定非致命性心肌梗死、充血性心力衰竭、血运重建需求和死亡情况。108例患者中，26例发生心脏事件。游离F(2)-异前列腺素和胆碱水平（而非高敏C反应蛋白水平）可预测30天心脏事件。为确定胆碱和F(2)-异前列腺素水平在预测30天心脏事件中的价值，绘制了受试者工作曲线。这些标志物的最佳截断点为血清F(2)-异前列腺素水平124.5 pg/ml（r = 0.82）和血清胆碱水平30.5 μmol/L（r = 0.76）。F(2)-异前列腺素和胆碱的阳性预测值分别为57%和44%，阴性预测值分别为90%和89%。总之，血清胆碱和游离F(2)-异前列腺素是ACS心脏事件的预测指标。一个包含一系列生物标志物（包括肌钙蛋白、胆碱和游离F(2)-异前列腺素）的模型可能有助于预测ACS中未来事件风险更高的患者。
