| 이준원¹ , 유병수¹ , 윤영진¹ , 안성균¹ , 안민수¹ , 이승환¹ , 윤정한¹ , 조명찬², 안영근 ³ , 채성철⁴ |
Background and Objectives:
Cardiac troponin I (cTnI), high sensitivity C-reactive protein (hs-CRP), serum creatinine (sCr) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) have emerged as strong predictors of adverse events. Each has a different combination of diagnostic and prognostic attributes, therefore, a combination of markers may be able stratify AMI patients. Our aim is to evaluate the prognostic performance of each of these markers, individually, and in combination for prediction of adverse events in AMI patients, especially, in the era of high performance of echocardiography and PCI.
Methods: Of total 16264 acute myocardial infarction patients enrolled in, KORMI (Korean Registry of AMI), 4676 patients, who performed baseline measurements of TnI, CRP, Scr and NT-proBNP, were included. Adverse events (AEs) defined as composite endpoints of death, MI and TVR through 12 month were recorded.
Results:
Mean age was 65.0±12.5 years, 50.1% were women, and 38.1% had diabetes. Initial vital sign was 128/78 mmHg with HR 78/minute. Mean left ventricular ejection fraction was 52.4±53.5. Early period adverse event occurred in 8.2% including in-hospital death, 5.2% and long-term event at 12 month after discharge occurred in 16.2% including cardiac death 7.1% after admission. In a multivariable model that included each biomarker, an elevated TnI (hazard ratio [HR] 1.095, p=0.023), CRP (HR 1.03, p=0.388), sCr (HR 1.38, p= 0.014) and NT-proBNP (HR 1.40, p=0.000) each was an independent predictor of the composite endpoint at 30 days. In predictor of the composite endpoint at 12 month, only sCr (HR 1.54, p= 0.000) and NT-proBNP (HR 1.38, p=0.000) was independent risk factors. When patients were categorized on the basis of the number of elevated biomarkers at presentation, as biomarker added to number, risk ratio was significantly increased (p=0.01) in the composite endpoint.
Conclusion: Biomarkers reflecting myonecrosis (hsTnI), inflammation (CRP), renal injury (sCR) and myocardial stretch (NT-proBNP) provide complementary prognostic information in patients with AMI. When used together, these novel markers may provide superior risk stratification over a long-term major cardiac event.
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