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American Journal of Cardiology


Several clinically available cardiac biomarkers have established their prognostic value in patients with acute coronary syndromes. However, their relative prognostic significance in stable subjects has not been prospectively validated, either individually or in combination. The aim of this study was to evaluate the extent to which B-type natriuretic peptide, myeloperoxidase, and high-sensitivity C-reactive protein alone or together could be prognostic biomarkers in 3,635 consecutive stable patients without acute coronary syndrome who underwent elective diagnostic coronary angiography. After adjusting for traditional risk factors and renal function, each of the markers monitored was a significant predictor of incident major adverse cardiovascular events (death, nonfatal myocardial infarction, and stroke) over 3 years. A cardiac biomarker score based on the sum total of “positive” biomarkers provided independent prediction of future risk for incident major adverse cardiovascular events at 3 years (hazard ratio [HR] 7.61, 95% confidence interval [CI] 4.98 to 11.65, p <0.001), even after adjusted for traditional risk factors (HR 6.11, 95% CI 3.98 to 9.38, p <0.001). A positive cardiac biomarker score remained a strong and independent predictor of 3-year risk for major adverse cardiovascular events among those with normal glycemic control (HR 4.24, 95% CI 1.96 to 9.18, p <0.001), those with prediabetes (HR 7.62, 95% CI 3.87 to 15.01, p <0.001), and those with diabetes (HR 5.61, 95% CI 2.55 to 12.33, p <0.001), as well as within subjects without significant angiographic evidence of coronary artery disease (HR 10.82, 95% CI 3.82 to 30.6, p <0.001). In conclusion, an integrated assessment of cardiac biomarkers may provide independent prognostic value for long-term adverse clinical events in stable cardiac patients.


This research was supported in part by Grants P01HL087018-020001, P01HL076491-055328, 1R01HL103866, and 1RO1HL103931 from the National Institutes of Health, Bethesda, Maryland; Grant 1UL1RR024989 from the Cleveland Clinic Clinical Research Unit of the Case Western Reserve University CTSA, Cleveland, Ohio; and the LeDucq Foundation, Paris, France. Dr. Hazen is also supported in part by a gift from the Leonard Kreiger Fund, Cleveland, Ohio. Supplies and partial funding for performance of fasting lipid profiles, glucose, creatinine, apolipoprotein A1, apolipoprotein B, high-sensitivity C-reactive protein, myeloperoxidase, and B-type natriuretic peptide used in this study were provided by Abbott Laboratories, Inc., Abbott Park, Illinois.









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