A comparative study of biomarkers for risk prediction in acute coronary syndrome-Results of the SIESTA (Systemic Inflammation Evaluation in non-ST-elevation Acute coronary syndrome) study

Atherosclerosis. 2010 Oct;212(2):636-43. doi: 10.1016/j.atherosclerosis.2010.06.026. Epub 2010 Jun 19.


Objective: We compared the 1-year predictive value of several inflammatory and non-inflammatory biomarkers in ACS patients.

Methods: In 610 patients (73.0% male)--36.0% unstable angina (UA) and 64.0% NSTEMI--we assessed high-sensitivity C-reactive protein (hs-CRP), interleukins 6, 10 and 18, soluble CD40 ligand, P- and E-selectin, NT-proBNP, fibrinogen and cystatin C at hospital admission. Two outcomes at 1-year follow up were selected for analysis: (1) all-cause death, MI, UA, or coronary revascularization, and (2) all-cause death, and non-fatal MI. The effect of biomarker levels on endpoints was examined by the Cox proportional hazards model, and their discrimination ability with the C statistic (AUC).

Results: Of 549 patients (90.0%) who completed the 1-year follow up, 206 (37.5%) and 54 (8.9%) reached the first and second composite endpoints, respectively. None of the biomarkers studied improved prediction of the first endpoint. However, considered as continuous variables, and in combination, NT-proBNP and fibrinogen, increased the AUC from 0.64 (95% CI 0.55-0.72) to 0.73 (95% CI 0.64-0.81; p=0.02) for prediction of the second endpoint. Cut-off values for NT-proBNP and fibrinogen, regarding best sensitivity and specificity for prediction of the secondary endpoint were 1043.9 ng/L and 4.47 mg/dL, respectively. For these cut-off points, sensitivity, specificity, positive predictive value and negative predictive value were 40.5% vs 59.5%, 83.3% vs 67.1%, 18.8% vs 14.9% and 93.5% vs 94.4% for NT-proBNP and fibrinogen, respectively.

Conclusion: In ACS patients, inflammatory biomarkers offer modest incremental information to that provided by clinical risk markers. Fibrinogen and NT-proBNP measurements, however, improve cardiovascular risk prediction.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome / blood*
  • Aged
  • Angina, Unstable / pathology
  • Area Under Curve
  • Biomarkers / metabolism*
  • Cardiovascular Diseases / metabolism
  • Female
  • Humans
  • Inflammation
  • Macrophages / metabolism
  • Male
  • Middle Aged
  • Myocardial Infarction / metabolism
  • Natriuretic Peptide, Brain / chemistry
  • Proportional Hazards Models
  • Protein Structure, Tertiary
  • T-Lymphocytes / metabolism
  • Time Factors


  • Biomarkers
  • Natriuretic Peptide, Brain