In 1099 patients with acute MI, biomarkers including TRAIL-R2, CA-125, and FGF-23 predicted all-cause mortality, but their prognostic value was abrogated after adjusting for clinical variables.
Observational (n=1,099)
Do circulating biomarkers predict all-cause mortality, recurrent MI, and heart failure hospitalizations in patients with acute myocardial infarction?
While several novel biomarkers predicted mortality and heart failure in acute MI patients, their prognostic value was lost after adjusting for established clinical variables.
AIMS: There is a paucity of studies comprehensively comparing the prognostic value of larger arrays of biomarkers indicative of different pathobiological axes in acute myocardial infarction (MI). METHODS AND RESULTS: In this explorative investigation, we simultaneously analysed 175 circulating biomarkers reflecting different inflammatory traits, coagulation activity, endothelial dysfunction, atherogenesis, myocardial dysfunction and damage, apoptosis, kidney function, glucose-, and lipid metabolism. Measurements were performed in samples from 1099 MI patients (SWEDEHEART registry) applying two newer multimarker panels Proximity Extension Assay (Olink Bioscience), Multiple Reaction Monitoring mass spectrometry. The prognostic value of biomarkers regarding all-cause mortality, recurrent MI, and heart failure hospitalizations (median follow-up ≤6.6 years) was studied using Lasso analysis, a penalized logistic regression model that considers all biomarkers simultaneously while minimizing the risk for spurious findings. Tumour necrosis factor-related apoptosis-inducing ligand receptor 2 (TRAIL-R2), ovarian cancer-related tumour marker CA 125 (CA-125), and fibroblast growth factor 23 (FGF-23) consistently predicted all-cause mortality in crude and age/sex-adjusted analyses. Growth-differentiation factor 15 (GDF-15) was strongly predictive in the crude model. TRAIL-R2 and B-type natriuretic peptide (BNP) consistently predicted heart failure hospitalizations. No biomarker predicted recurrent MI. The prognostic value of all biomarkers was abrogated following additional adjustment for clinical variables owing to our rigorous statistical approach. CONCLUSION: Apart from biomarkers with established prognostic value (i.e. BNP and to some extent GDF-15), several 'novel' biomarkers (i.e. TRAIL-R2, CA-125, FGF-23) emerged as risk predictors in patients with MI. Our data warrant further investigation regarding the utility of these biomarkers for clinical decision-making in acute MI.
Eggers et al. (Mon,) conducted a observational in acute myocardial infarction (n=1,099). 175 circulating biomarkers was evaluated on all-cause mortality, recurrent MI, and heart failure hospitalizations. In 1099 patients with acute MI, biomarkers including TRAIL-R2, CA-125, and FGF-23 predicted all-cause mortality, but their prognostic value was abrogated after adjusting for clinical variables.