Predicting Adverse Events in ACS Patients

A study has shown that the use of two markers, cardiac troponin T (cTnT) and N-terminus pro-B-type natriuretic peptide (NT-proBNP), is better for predicting adverse events among patients with acute coronary syndrome (ACS) than any of the following three markers alone: cTnT, high sensitivity C-reative protein (hs-CRP), and NT-proBNP.

Researchers obtained serum samples from 422 patients presenting to the emergency department at The Johns Hopkins Hospital (Baltimore, MD, USA) with symptoms of acute coronary syndrome. The samples were subsequently tested for cTnT, NT-proBNP, and hs-CRP by modular analytic systems. Adverse events occurring within 30 days (death, myocardial infarction, unstable angina, and revascularization procedures) were recorded by chart review, phone, and mail survey.

Adverse events occurred in 42 patients (10%). Relative risk, cut-off, and predictive values for each biomarker were determined statistically, with the exception of cTnT, where the concentration meeting the 10% coefficient of variation was used.

The results showed that cTnT appeared to have a better prognostic performance when compared to hs-CRP and NT-proBNP. The combination of cTnT and NT-proBNP performed better than the combination of cTnT and hs-CRP. When all three biomarkers were used as a panel, there was no significant improvement over cTnT or NT-proBNP. Thus, the combination of cTnT and NT-proBNP shows enhanced prognostic ability over each of these biomarkers when used alone. The results of the study were presented at the annual meeting of the American Association of Clinical Chemistry in Los Angeles (CA, USA) in July 2004.




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