Key result
In NSTE-ACS patients treated with an early invasive strategy, admission levels of hs-cTnT, NT-proBNP, and hsCRP were not significantly associated with the risk of recurrent cardiovascular events at 1 year.
Why the study?
Patients with NSTE-ACS represent a heterogeneous population, and improved identification of specific risk profiles using biomarkers is needed for those undergoing routine invasive diagnostics within 24 hours.
Do admission biomarker levels (hs-cTnT, NT-proBNP, hsCRP) predict 1-year clinical events in NSTE-ACS patients treated with an early invasive strategy?
Cohort (n=249)
Open-label
No
Do admission biomarker levels (hs-cTnT, NT-proBNP, hsCRP) predict 1-year clinical events in NSTE-ACS patients treated with an early invasive strategy?
In NSTE-ACS patients treated with an early invasive strategy and modern medical therapy, admission biomarker levels (hs-cTnT, NT-proBNP, hsCRP) did not significantly predict recurrent cardiovascular events at 1 year.
Answers are grounded in this paper and cite their sources.
Immediate invasive strategy yields no infarct-size benefit over early in NSTE-ACS; challenges routine immediate catheterization and extends timing-trial evidence.
Background: Patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) consists of a heterogenic population and improvement in identification of a specific risk profile is needed. In this study we aimed to obtain better insight in the role of different biomarkers for patients undergoing a routine invasive diagnostic strategy within 24 hours after admission. Methods: An Immediate or Early Invasive Strategy in Non-ST-Elevation Acute Coronary Syndrome (OPTIMA-2) study was a randomized controlled prospective open-label multicentre trial, randomizing NSTE-ACS patients. An invasive strategy was either immediate (<3 hours) or early (12–24 hours). Peak high-sensitive TroponinT (hsTropT) value was determined within the first 48 hours of admission. N-terminal proB-type natriuretic peptide (NTpro-BNP) and high-sensitivity C-reactive protein (hsCRP) values were determined at admission and at discharge. These biomarkers were then divided into tertiles and related to clinical outcomes up to one year. The relation between these biomarkers and myocardial function recovery established by echocardiography was analyzed as a secondary endpoint. Results: The OPTIMA-2 study included 249 patients. Overall, there was no significant increase in the risk of developing an adverse cardiovascular event in the first year if biomarker tertiles at admission were compared. However, mean NT-proBNP levels at admission were higher for patients that experienced all-cause death withing the first year (1.93 ± 0.49 vs 1.42 ± 0.58, p = 0.05). Also, peak hs-cTnT (232.0 ± 2846.0 vs 71.5 ± 1152.0, p = 0.06) values at baseline were higher in patients experiencing a myocardial infarction within 1-year. NT-proBNP levels at admission and at discharge correlated with recovery of the left ventricular (LV) function at 30 days (coefficient 0.021 (95% CI = 0.009–0.033) and coefficient 0.016 (95% CI = 0.005–0.027)). Conclusions: In NSTE-ACS patients treated by an early invasive strategy and administration of modern anticoagulant and antiplatelet therapy, multiple biomarker measurements during admission could not predict the occurrence of recurrent cardiovascular events within the first year of follow-up.
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Fagel et al. (2023) conducted a cohort in Non-ST-elevation acute coronary syndrome (NSTE-ACS) (n=249). Peak hs-cTnT (highest tertile) vs. Peak hs-cTnT (lowest tertile) was evaluated on Major adverse cardiac events (MACE) at 1 year (HR 1.90, 95% CI 0.61-5.92, p=0.24). In NSTE-ACS patients treated with an early invasive strategy, admission levels of hs-cTnT, NT-proBNP, and hsCRP were not significantly associated with the risk of recurrent cardiovascular events at 1 year.
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