Multimarker risk strategy for predicting 1-month and 1-year major events in non-ST-elevation acute coronary syndromes

Background The aim of this study was to define the utility of the combined measurement of troponin 1, myoglobin, C-reactive protein, fibrinogen, and homocysteine to predict risk in non-ST elevation acute coronary syndromes. Methods Troponin 1, myoglobin, high-sensitivity C-reactive protein, fibrinogen, and homocysteine were measured in 557 consecutive patients admitted to our institution for non-ST elevation acute coronary syndrome. The risk for major events (death or nonfatal myocardial infarction) at first month and at first year follow-up was analyzed. Results In a multivariate model adjusting for baseline characteristics and electrocardiographic changes, the only biomarkers related to major events at first month were C-reactive protein (P =.007) and myoglobin (P =.02), and at first year troponin I (P =.02), C-reactive protein (P =.03), and homocysteine (P =.04). The rate of major events depending on the number (0-5) of elevated biomarkers were at first month: 4.1%, 3.7%, 5.7%, 6.1%, 6.5%, and 30.8% (P <.0001), and at first year: 8.2%, 11.1%, 12.3%, 16.2%, 23.7%, and 50% (P <.0001). A simple score including the number of elevated biomarkers showed an adjusted risk of major events of 1.6 [1.3-1.9] at first month and of 1.4 [1.2-1.7] at first year. Conclusions Markers of myocardial damage, inflammation, and homocysteine analyzed separately provide prognostic information. The number of elevated biomarkers is an independent risk predictor of major events.