Multimarker Risk Stratification in Patients With Acute Myocardial Infarction
Key result
A multimarker risk score adding ST2, troponin T, and MPO to the TIMI STEMI Risk Score improved the C-statistic for 30-day cardiovascular death or heart failure from 0.75 to 0.82 (P=0.001).
Why the study?
Does a multimarker risk score improve prediction of cardiovascular death or heart failure in patients with STEMI compared to the TIMI STEMI Risk Score alone?
Population
Up to 1258 patients with ST-elevation myocardial infarction (STEMI) from the CLARITY-TIMI 28 trial
Comparison
Multimarker risk score combining biomarkers of… vs TIMI STEMI Risk Score alone
Design
Cohort
Follow-up
30 days
Authors
Discussion
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Member takes
Implication
May refine STEMI risk stratification; hypothesis-generating and requires prospective validation before practice change.
Study Design
Type
Cohort (n=1,258)
Structured PICO
Does a multimarker risk score improve prediction of cardiovascular death or heart failure in patients with STEMI compared to the TIMI STEMI Risk Score alone?
P
Population
1,258 patients with ST-elevation myocardial infarction from the CLARITY-TIMI 28 trial, followed for 30 days.
E
Exposure
Multimarker risk score combining biomarkers of myocardial stress (ST2), myonecrosis (troponin T), and inflammation (MPO)
C
Comparator
TIMI STEMI Risk Score alone
O
Outcome
Composite of cardiovascular death or heart failure (HF) through 30 dayscomposite
Main Result
Effect estimate: C-statistic 0.82 (95% CI 0.78-0.87)
p-value: p=0.001
A multimarker strategy combining ST2, troponin T, and MPO significantly improves 30-day risk prediction for cardiovascular death or heart failure in STEMI patients when added to the TIMI STEMI Risk Score.
Cite This Study
O’Donoghue et al. (2016) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=1,258). Multimarker risk score (ST2, troponin T, and MPO) vs. TIMI STEMI Risk Score alone was evaluated on Cardiovascular death or heart failure (HF) through 30 days (C-statistic 0.82, 95% CI 0.78-0.87, p=0.001). A multimarker risk score adding ST2, troponin T, and MPO to the TIMI STEMI Risk Score improved the C-statistic for 30-day cardiovascular death or heart failure from 0.75 to 0.82 (P=0.001).