Multiple marker approach to risk stratification in patients with stable coronary artery disease
Standard
Multiple marker approach to risk stratification in patients with stable coronary artery disease. / Schnabel, Renate B; Schulz, Andreas; Messow, C Martina; Lubos, Edith; Wild, Philipp S; Zeller, Tanja; Sinning, Christoph R; Rupprecht, Hans J; Bickel, Christoph; Peetz, Dirk; Cambien, François; Kempf, Tibor; Wollert, Kai C; Benjamin, Emelia J; Lackner, Karl J; Münzel, Thomas F; Tiret, Laurence; Vasan, Ramachandran S; Blankenberg, Stefan.
In: EUR HEART J, Vol. 31, No. 24, 12.2010, p. 3024-3031.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Multiple marker approach to risk stratification in patients with stable coronary artery disease
AU - Schnabel, Renate B
AU - Schulz, Andreas
AU - Messow, C Martina
AU - Lubos, Edith
AU - Wild, Philipp S
AU - Zeller, Tanja
AU - Sinning, Christoph R
AU - Rupprecht, Hans J
AU - Bickel, Christoph
AU - Peetz, Dirk
AU - Cambien, François
AU - Kempf, Tibor
AU - Wollert, Kai C
AU - Benjamin, Emelia J
AU - Lackner, Karl J
AU - Münzel, Thomas F
AU - Tiret, Laurence
AU - Vasan, Ramachandran S
AU - Blankenberg, Stefan
PY - 2010/12
Y1 - 2010/12
N2 - 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 consisting of the classical risk factors assessed by C-index and led to substantial reclassification (P-integrated discrimination improvement <0.05).CONCLUSION: comparative analysis of 12 biomarkers revealed Nt-proBNP, GDF-15, MR-proANP, cystatin C, and MR-proADM as the strongest predictors of cardiovascular outcome in stable angina. All five biomarkers taken separately offered incremental predictive ability over established risk factors. Combination of the single markers slightly improved model fit but did not enhance risk prediction from a clinical perspective.
AB - 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 consisting of the classical risk factors assessed by C-index and led to substantial reclassification (P-integrated discrimination improvement <0.05).CONCLUSION: comparative analysis of 12 biomarkers revealed Nt-proBNP, GDF-15, MR-proANP, cystatin C, and MR-proADM as the strongest predictors of cardiovascular outcome in stable angina. All five biomarkers taken separately offered incremental predictive ability over established risk factors. Combination of the single markers slightly improved model fit but did not enhance risk prediction from a clinical perspective.
KW - Aged
KW - Angina, Stable/blood
KW - Biomarkers/metabolism
KW - Coronary Artery Disease/blood
KW - Female
KW - Humans
KW - Kaplan-Meier Estimate
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/blood
KW - Prognosis
KW - Prospective Studies
KW - Risk Assessment
U2 - 10.1093/eurheartj/ehq322
DO - 10.1093/eurheartj/ehq322
M3 - SCORING: Journal article
C2 - 20852293
VL - 31
SP - 3024
EP - 3031
JO - EUR HEART J
JF - EUR HEART J
SN - 0195-668X
IS - 24
ER -
