Biomarkers Improve Cardiovascular Risk Prediction After STEMI

MedicalResearch.com Interview with:
Matthijs A. Velders, MD PhD

Uppsala Clinical Research Center
Uppsala, Sweden.

Medical Research: What is the background for this study? What are the main findings?

Dr. Velders: Outcomes in patients with ST-elevation myocardial infarction have been substantially improved by early reperfusion with primary percutaneous coronary intervention, but recurrent events after the acute phase of myocardial infarction are common. To continue to improve outcome for these patients, identification of high-risk patients is essential. While conventional risk scores rely on clinical and angiographic data for risk stratification, markers of myocardial dysfunction (N-terminal pro-B-type natriuretic peptide, NT-proBNP), myocardial necrosis (high-sensitivity cardiac troponin-T, cTnT-hs) and oxidative stress (growth differentiation factor-15, GDF-15) have been shown to improve risk prediction over traditional risk factors. However, the incremental value of these biomarkers beyond clinical risk factors and angiographic extent of coronary artery disease in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention remained unclear.

In this substudy of the PLATO trial (NCT00391872), biomarkers were measured shortly after admission in 5385 patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. We found that cTnT-hs, NT-proBNP and GDF-15 as well as the angiographic extent of coronary artery disease improved the prediction of cardiovascular death during follow-up in comparison to clinical information alone. The predictive value of the three biomarkers was similar for cardiovascular death and independent of the extent of coronary artery disease. Furthermore, NT-proBNP and GDF-15 showed prognostic value for spontaneous myocardial infarction during follow-up. Thus, for prognostication of both cardiovascular death and spontaneous myocardial infarction after primary percutaneous coronary intervention in ST-elevation myocardial infarction, NT-proBNP as well as GDF-15 will provide useful information beyond what currently is available from clinical and angiographic data.

Medical Research: What should clinicians and patients take away from your report?

Dr. Velders: Biomarker measurement on admission is an objective tool to aid the physician in the early recognition of high-risk patients with ST-elevation myocardial infarction. This potentially allows early initiation of more intensive treatment and intensified follow-up after discharge in attempt to lower the risk for new cardiac events. However, the current study does not answer the question as to how to use the prognostic information provided by the biomarkers.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Velders: Future investigations should explore biomarker-guided management strategies in patients with ST-elevation myocardial infarction.

Citation:

Biomarkers for Risk Stratification of Patients with ST-Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention: Insights from the Platelet Inhibition and Patient Outcomes (PLATO) Trial

Matthijs A. Velders, MD, PhD, Lars Wallentin, MD, PhD et al
on behalf of the PLATO Investigators American Heart Journal Available online 4 March 2015

 

MedicalResearch.com Interview with:Matthijs A. Velders, MD PhD (2015). Biomarkers Improve Cardiovascular Risk Prediction After STEMI 

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