Fagel Nick D, Vink Maarten A, Heestermans Antonius A C M, Riezebos Robert K
Heart Center, OLVG Hospital, 1091 AC Amsterdam, The Netherlands.
Heart Center, NWZ Hospital, 1815 JD Alkmaar, The Netherlands.
Rev Cardiovasc Med. 2023 Apr 18;24(4):117. doi: 10.31083/j.rcm2404117. eCollection 2023 Apr.
Patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) consists of a heterogenic population and improvement in identification of a specific risk profile is needed. In this study we aimed to obtain better insight in the role of different biomarkers for patients undergoing a routine invasive diagnostic strategy within 24 hours after admission.
An Immediate or Early Invasive Strategy in Non-ST-Elevation Acute Coronary Syndrome (OPTIMA-2) study was a randomized controlled prospective open-label multicentre trial, randomizing NSTE-ACS patients. An invasive strategy was either immediate ( 3 hours) or early (12-24 hours). Peak high-sensitive TroponinT (hsTropT) value was determined within the first 48 hours of admission. N-terminal proB-type natriuretic peptide (NTpro-BNP) and high-sensitivity C-reactive protein (hsCRP) values were determined at admission and at discharge. These biomarkers were then divided into tertiles and related to clinical outcomes up to one year. The relation between these biomarkers and myocardial function recovery established by echocardiography was analyzed as a secondary endpoint.
The OPTIMA-2 study included 249 patients. Overall, there was no significant increase in the risk of developing an adverse cardiovascular event in the first year if biomarker tertiles at admission were compared. However, mean NT-proBNP levels at admission were higher for patients that experienced all-cause death withing the first year (1.93 0.49 vs 1.42 0.58, = 0.05). Also, peak hs-cTnT (232.0 2846.0 vs 71.5 1152.0, = 0.06) values at baseline were higher in patients experiencing a myocardial infarction within 1-year. NT-proBNP levels at admission and at discharge correlated with recovery of the left ventricular (LV) function at 30 days (coefficient 0.021 (95% CI = 0.009-0.033) and coefficient 0.016 (95% CI = 0.005-0.027)).
In NSTE-ACS patients treated by an early invasive strategy and administration of modern anticoagulant and antiplatelet therapy, multiple biomarker measurements during admission could not predict the occurrence of recurrent cardiovascular events within the first year of follow-up.
非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者群体异质性大，需要改进特定风险特征的识别方法。在本研究中，我们旨在更深入了解不同生物标志物在入院后24小时内接受常规侵入性诊断策略的患者中的作用。
非ST段抬高型急性冠状动脉综合征的即时或早期侵入性策略（OPTIMA-2）研究是一项随机对照前瞻性开放标签多中心试验，对NSTE-ACS患者进行随机分组。侵入性策略分为即时（≤3小时）或早期（12 - 24小时）。在入院后的前48小时内测定高敏肌钙蛋白T（hsTropT）峰值。在入院时和出院时测定N末端B型利钠肽原（NTpro-BNP）和高敏C反应蛋白（hsCRP）值。然后将这些生物标志物分为三分位数，并与长达一年的临床结局相关联。将这些生物标志物与通过超声心动图确定的心肌功能恢复之间的关系作为次要终点进行分析。
OPTIMA-2研究纳入了249例患者。总体而言，比较入院时生物标志物三分位数，第一年发生不良心血管事件的风险没有显著增加。然而，在第一年内发生全因死亡的患者入院时平均NT-proBNP水平较高（1.93±0.49 vs 1.42±0.58，P = 0.05）。此外，在1年内发生心肌梗死的患者基线时的hs-cTnT峰值（232.0±2846.0 vs 71.5±1152.0，P = 0.06）也较高。入院时和出院时的NT-proBNP水平与30天时左心室（LV）功能的恢复相关（系数0.021（95%CI = 0.009 - 0.033）和系数0.016（95%CI = 0.005 - 0.027））。
在采用早期侵入性策略并给予现代抗凝和抗血小板治疗的NSTE-ACS患者中，入院期间多次生物标志物测量无法预测随访第一年内复发性心血管事件的发生。
