Multiple marker approach to risk stratification in patients with stable coronary artery disease

作者：Renate B. Schnabel, Andreas Schulz, Claudia‐Martina Messow, Edith Lubos, Philipp Sebastian Wild, Tanja Zeller, Christoph Sinning, Hans J. Rupprecht, Christoph Bickel, Dirk Peetz, François Cambien, Tibor Kempf, Kai Christoph Wollert, Emelia J. Benjamin, Karl Johannes Lackner, Thomas F. Münzel, Laurence Tiret, Ramachandran Srini Vasan, Stefan Blankenberg · 发表于：European Heart Journal · 年份：2010 · DOI：10.1093/eurheartj/ehq322 · 被引用次数：112 · 研究领域：GDF15 and Related Biomarkers、IL-33, ST2, and ILC Pathways、Adipokines, Inflammation, and Metabolic Diseases

AIMS: multimarker approaches for risk prediction in coronary artery disease have remained inconsistent. We assessed multiple biomarkers representing distinct pathophysiological pathways in relation to cardiovascular events in stable angina. METHODS AND RESULTS: we investigated 12 biomarkers reflecting inflammation [C-reactive protein, growth-differentiation factor (GDF)-15, neopterin], lipid metabolism (apolipoproteins AI, B100), renal function (cystatin C, serum creatinine), and cardiovascular function and remodelling [copeptin, C-terminal-pro-endothelin-1, mid-regional-pro-adrenomedullin (MR-proADM), mid-regional-pro-atrial natriuretic peptide (MR-proANP), N-terminal-pro-B-type natriuretic peptide (Nt-proBNP)] in 1781 stable angina patients in relation to non-fatal myocardial infarction and cardiovascular death (n = 137) over 3.6 years. Using Cox proportional hazards models and C-indices, the strongest association with outcome for log-transformed biomarkers in multivariable-adjusted analyses was observed for Nt-proBNP [hazard ratio (HR) for one standard deviation increase 1.65, 95% confidence interval (CI) 1.28-2.13, C-index 0.686], GDF-15 (HR 1.59, 95% CI 1.25-2.02, C-index 0.681), MR-proANP (HR 1.46, 95% CI 1.14-1.87, C-index 0.673), cystatin C (HR 1.39, 95% CI 1.10-1.75, C-index 0.671), and MR-proADM (HR 1.63, 95% CI 1.21-2.20, C-index 0.668). Each of these top single markers and their combination (C-index 0.690) added predictive information beyond the baseline model con...