Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
Department of Cardiology, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, the Netherlands.
Eur Heart J Acute Cardiovasc Care. 2023 Jul 7;12(7):451-461. doi: 10.1093/ehjacc/zuad042.
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.
关于生物标志物连续测量在急性冠脉综合征（ACS）后患者风险评估中的作用的证据有限。本研究旨在探讨在一个大型真实世界的 ACS 后患者队列中，四种连续测量的生物标志物的预后价值。
BIOMArCS 是一项前瞻性、多中心、观察性研究，纳入了 844 名 ACS 后患者，在 1 年随访期间共采集了 12218 份血样（每名患者中位数为 17 份）。使用多变量联合模型分析高敏心肌肌钙蛋白 T（hs-cTnT）、N 末端 B 型利钠肽前体（NT-proBNP）、高敏 C 反应蛋白（hs-CRP）和生长分化因子 15（GDF-15）的纵向变化与主要终点（PE）心血管死亡率和复发性 ACS 的关系。中位年龄为 63 岁，78%为男性，45 名患者达到 PE。与无 PE 患者相比，PE 患者的平均生物标志物水平普遍更高。在校正 6 个月后出院全球急性冠脉事件评分后，log[hs-cTnT]每增加 1 个标准差，PE 的风险增加 61%[危险比（HR）1.61，95%置信区间（CI）1.02-2.44，P=0.045]，而 log[GDF-15]则增加 81%（HR 1.81，95%CI 1.28-2.70，P=0.001）。这些关联在多变量调整后仍然显著，而 NT-proBNP 和 hs-CRP 则不然。此外，GDF-15 水平在 PE 发生前呈上升趋势（结构化图表摘要）。
在 ACS 后临床稳定患者的风险评估中，连续测量的 hs-cTnT 和 GDF-15 浓度提供了预后价值。
荷兰临床试验注册处。目前可在 URL https://trialsearch.who.int/ 上获得；唯一标识符：NTR1698 和 NTR1106。
