Serially measured high-sensitivity cardiac troponin T, N-terminal-pro-B-type natriuretic peptide, high-sensitivity C-reactive protein, and growth differentiation factor 15 for risk assessment after acute coronary syndrome: the BIOMArCS cohort

Eur Heart J Acute Cardiovasc Care. 2023 Jul 7;12(7):451-461. doi: 10.1093/ehjacc/zuad042.

Abstract

Aims: 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.

Methods and results: 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).

Conclusion: Longitudinally measured hs-cTnT and GDF-15 concentrations provide prognostic value in the risk assessment of clinically stabilized patients post-ACS.

Clinical trial registration: The Netherlands Trial Register. Currently available at URL https://trialsearch.who.int/; Unique Identifiers: NTR1698 and NTR1106.

Keywords: Acute coronary syndrome; Biomarkers; Prognosis; Repeated measurements; Risk assessment.

Publication types

  • Observational Study

MeSH terms

  • Acute Coronary Syndrome*
  • Aftercare
  • Biomarkers
  • C-Reactive Protein* / metabolism
  • Female
  • Growth Differentiation Factor 15
  • Humans
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain
  • Patient Discharge
  • Peptide Fragments
  • Prognosis
  • Prospective Studies
  • Risk Assessment / methods
  • Troponin T

Substances

  • C-Reactive Protein
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain
  • Troponin T
  • Growth Differentiation Factor 15
  • Biomarkers
  • Peptide Fragments