Prognostic Value of a Multimarker Approach for Patients Presenting to Hospital With Acute Chest Pain

To evaluate the prognostic role of novel biomarkers for the risk stratification of patients admitted with ischemic-type chest pain, a prospective study of 664 patients presenting to 2 coronary care units with ischemic-type chest pain was conducted over 3 years beginning in 2003. Patients were assessed on admission for clinical characteristics, electrocardiographic findings, renal function, cardiac troponin T (cTnT), markers of myocyte injury (heart fatty acid–binding protein [H-FABP] and glycogen phosphorylase BB), neurohormonal activation (N-terminal–pro-brain natriuretic peptide [NT–pro-BNP]), hemostatic activity (fibrinogen and d-dimer), and vascular inflammation (high-sensitivity C-reactive protein, myeloperoxidase, matrix metalloproteinase–9, pregnancy-associated plasma protein–A, and soluble CD40 ligand). A ≥12-hour cTnT sample was also obtained. Myocardial infarction (MI) was defined as peak cTnT ≥0.03 μg/L. Patients were followed for 1 year from the time of admission. The primary end point was death or MI. Elevated fibrinogen, d-dimer, H-FABP, NT–pro-BNP, and peak cTnT were predictive of death or MI within 1 year (unadjusted odds ratios 2.5, 3.1, 5.4, 5.4, and 6.9, respectively). On multivariate analysis, H-FABP and NT–pro-BNP were selected, in addition to age, peak cTnT, and left ventricular hypertrophy on initial electrocardiography, as significant independent predictors of death or MI within 1 year. Patients without elevations of H-FABP, NT–pro-BNP, or peak cTnT formed a very low risk group in terms of death or MI within 1 year. A very high risk group had elevations of all 3 biomarkers. In conclusion, the measurement of H-FABP and NT–pro-BNP at the time of hospital admission for patients with ischemic-type chest pain adds useful prognostic information to that provided by the measurement of baseline and 12-hour cTnT.