- 作者：Danny J. Eapen ; Pankaj Manocha ; Riyaz S. Patel ; Muhammad Hammadah ; Emir Veledar ; Christina Wassel ; Ravi A. Nanjundappa ; Sergey Sikora ; Dylan Malayter ; Peter W.F. Wilson ; Laurence Sperling ; Arshed A. Quyyumi ; Stephen E. Epstein
- 关键词：biomarker ; C-reactive protein ; fibrin degradation product ; heat shock protein ; myocardial infarction
- 刊名：Journal of the American College of Cardiology
- 出版年：2013
- 出版时间：23 July, 2013
- 年：2013
- 卷：62
- 期：4
- 页码：329-337
- 全文大小：606 K
Objectives
This study sought to determine an aggregate, pathway-specific risk score for enhanced prediction of death?and myocardial infarction (MI).Background
Activation of inflammatory, coagulation, and cellular stress pathways contribute to atherosclerotic plaque rupture.?We hypothesized that an aggregate risk score comprised of biomarkers involved in these different pathways¡ªhigh-sensitivity C-reactive protein (CRP), fibrin degradation products (FDP), and heat shock protein 70?(HSP70) levels¡ªwould be a powerful predictor of death and MI.
Methods
Serum levels of CRP, FDP, and HSP70 were measured in 3,415 consecutive patients with suspected or confirmed coronary artery disease (CAD) undergoing cardiac catheterization. Survival analyses were performed with models adjusted for established risk factors.
Results
Median follow-up was 2.3 years. Hazard ratios (HRs) for all-cause death and MI based on cutpoints were as follows: CRP?¡Ý3.0 mg/l, HR: 1.61; HSP70 >0.625 ng/ml, HR; 2.26; and FDP?¡Ý1.0 ¦Ìg/ml, HR: 1.62 (p?< 0.0001 for all). An?aggregate biomarker score between 0 and 3 was calculated based on these cutpoints. Compared with the group?with a 0 score, HRs for all-cause death and MI were 1.83, 3.46, and 4.99 for those with scores of 1, 2, and 3, respectively (p for each:?<0.001). Annual event rates were 16.3 % for the 4.2 % of patients with a score of 3 compared with 2.4 % in 36.4 % of patients with a score of 0. The C statistic and net reclassification improved (p?<?0.0001) with the addition of the biomarker score.
Conclusions
An aggregate score based on serum levels of CRP, FDP, and HSP70 is a predictor of future risk of death and MI in?patients with suspected or known CAD.