Wang Le, Cong Hong-Liang, Zhang Jing-Xia, Li Xi-Ming, Hu Yue-Cheng, Wang Chen, Lang Jia-Chun, Zhou Bing-Yang, Li Ting-Ting, Liu Chun-Wei, Yang Hua, Ren Li-Bin, Qi Wei, Li Wen-Yu
Department of Cardiology, Tianjin Chest Hospital, Tianjin, China.
Front Cardiovasc Med. 2022 Jul 27;9:916085. doi: 10.3389/fcvm.2022.916085. eCollection 2022.
Acute coronary syndrome (ACS) without standard modifiable cardiovascular risk factors (SMuRFs) represents a special case of ACS. Multiple biomarkers have been shown to improve risk stratification in patients with ACS. However, the utility of biomarkers for prognostic stratification in patients with ACS without SMuRFs remains uncertain. The aim of the present study was to evaluate the prognostic value of various biomarkers in patents with ACS without SMuRFs.
Data of consecutive patients with ACS without SMuRFs who underwent coronary angiography in Tianjin Chest Hospital between January 2014 and December 2017 were retrospectively collected. The primary outcome was the occurrence of major adverse cardiovascular event (MACE), defined as a composite of cardiovascular death, myocardial infarction and stroke. Seven candidate biomarkers analyses were analyzed using models adjusted for established risk factors.
During a median 5-year follow-up, 81 of the 621 patients experienced a MACE. After adjustment for important covariates, elevated fibrinogen, D-dimer, N-terminal proB-type natriuretic peptide (NT-proBNP), and lipoprotein (a) [Lp(a)] were found to be individually associated with MACE. However, only D-dimer, NT-proBNP and Lp(a) significantly improved risk reclassification for MACE (all < 0.05). The multimarker analysis showed that there was a clear increase in the risk of MACE with an increasing number of elevated biomarkers and a higher multimarker score. The adjusted hazard ratio- for MACE (95% confidential intervals) for patients with 4 elevated biomarkers was 6.008 (1.9650-18.367) relative to those without any elevated biomarker-. Adding- the 4 biomarkers or the multimarker score to the basic model significantly improved the C-statistic value, the net reclassification index and the integrated discrimination index (all < 0.05).
Fibrinogen, D-dimer, NT-proBNP and Lp(a) provided valuable prognostic information for MACE when applied to patients with ACS without SMuRFs. The multimarker strategy, which combined multiple biomarkers reflecting different pathophysiological process with traditional risk factors improved the cardiovascular risk stratification.
无标准可改变心血管危险因素（SMuRFs）的急性冠状动脉综合征（ACS）是ACS的一种特殊情况。多种生物标志物已被证明可改善ACS患者的风险分层。然而，生物标志物在无SMuRFs的ACS患者预后分层中的作用仍不确定。本研究的目的是评估各种生物标志物在无SMuRFs的ACS患者中的预后价值。
回顾性收集2014年1月至2017年12月在天津胸科医院接受冠状动脉造影的无SMuRFs的连续ACS患者的数据。主要结局是主要不良心血管事件（MACE）的发生，定义为心血管死亡、心肌梗死和中风的复合事件。使用针对既定危险因素进行调整的模型分析了7种候选生物标志物。
在中位5年的随访期间，621例患者中有81例发生了MACE。在对重要协变量进行调整后，发现纤维蛋白原、D-二聚体、N末端前B型利钠肽（NT-proBNP）和脂蛋白（a）[Lp（a）]升高分别与MACE相关。然而，只有D-二聚体、NT-proBNP和Lp（a）显著改善了MACE的风险重新分类（均P<0.05）。多标志物分析表明，随着升高的生物标志物数量增加和多标志物评分升高，MACE风险明显增加。与没有任何升高生物标志物的患者相比，有4种升高生物标志物的患者MACE的调整后风险比（95%置信区间）为6.008（1.9650-18.367）。将这4种生物标志物或多标志物评分添加到基本模型中显著提高了C统计值、净重新分类指数和综合判别指数（均P<0.05）。
当应用于无SMuRFs的ACS患者时，纤维蛋白原、D-二聚体、NT-proBNP和Lp（a）为MACE提供了有价值的预后信息。将反映不同病理生理过程的多种生物标志物与传统危险因素相结合的多标志物策略改善了心血管风险分层。
