Biomarker-Based Prediction of Recurrent Ischemic Events in Patients With Acute Coronary Syndromes

Background: In patients with acute coronary syndrome (ACS), there is residual and variable risk of recurrent ischemic events.

Objectives: This study aimed to develop biomarker-based prediction models for 1-year risk of cardiovascular (CV) death and myocardial infarction (MI) in patients with ACS undergoing percutaneous coronary intervention.

Methods: We included 10,713 patients from the PLATO (A Comparison of Ticagrelor [AZD6140] and Clopidogrel in Patients With Acute Coronary Syndrome) trial in the development cohort and externally validated in 3,508 patients from the TRACER (Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome) trial. Variables contributing to risk of CV death/MI were assessed using Cox regression models, and a score was derived using subsets of variables approximating the full model.

Results: There were 632 and 190 episodes of CV death/MI in the development and validation cohorts. The most important predictors of CV death/MI were the biomarkers, growth differentiation factor 15, and N-terminal pro-B-type natriuretic peptide, which had greater prognostic value than all candidate variables. The final model included 8 items: age (A), biomarkers (B) (growth differentiation factor 15 and N-terminal pro-B-type natriuretic peptide), and clinical variables (C) (extent of coronary artery disease, previous vascular disease, Killip class, ACS type, P2Y12 inhibitor). The model, named ABC-ACS ischemia, was well calibrated and showed good discriminatory ability for 1-year risk of CV death/MI with C-indices of 0.71 and 0.72 in the development and validation cohorts, respectively. For CV death, the score performed better, with C-indices of 0.80 and 0.84 in the development and validation cohorts, respectively.

Conclusions: An 8-item score for the prediction of CV death/MI was developed and validated for patients with ACS undergoing percutaneous coronary intervention. The ABC-ACS ischemia score showed good calibration and discrimination and might be useful for risk prediction and decision support in patients with ACS. (A Comparison of Ticagrelor [AZD6140] and Clopidogrel in Patients With Acute Coronary Syndrome [PLATO]; NCT00391872; Trial to Assess the Effects of Vorapaxar [SCH 530348; MK-5348] in Preventing Heart Attack and Stroke in Participants With Acute Coronary Syndrome [TRACER]; NCT00527943).

 

Comments:

The study you described aimed to develop biomarker-based prediction models for the 1-year risk of cardiovascular (CV) death and myocardial infarction (MI) in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention. The researchers used data from the PLATO trial, which included 10,713 patients, and externally validated their models using data from the TRACER trial, which included 3,508 patients.

The researchers identified variables that contributed to the risk of CV death or MI using Cox regression models. They found that two biomarkers, growth differentiation factor 15 and N-terminal pro-B-type natriuretic peptide, were the most important predictors and had greater prognostic value than other candidate variables.

Based on their analysis, the researchers developed a prediction model named ABC-ACS ischemia, which included 8 items: age (A), biomarkers (B) (growth differentiation factor 15 and N-terminal pro-B-type natriuretic peptide), and clinical variables (C) (extent of coronary artery disease, previous vascular disease, Killip class, ACS type, P2Y12 inhibitor). The model showed good calibration and discriminatory ability for predicting the 1-year risk of CV death or MI, with C-indices of 0.71 and 0.72 in the development and validation cohorts, respectively.

For the specific outcome of CV death, the ABC-ACS ischemia score performed even better, with C-indices of 0.80 and 0.84 in the development and validation cohorts, respectively.

In conclusion, the ABC-ACS ischemia score, based on the 8-item model, was developed and validated for predicting the 1-year risk of CV death or MI in patients with ACS who underwent percutaneous coronary intervention. The score showed good calibration and discrimination and could potentially be useful for risk prediction and decision support in patients with ACS.

Related Products

Cat.No.	Product Name	Information
S8067	Vorapaxar (MK-5348)	Vorapaxar (SCH 530348, MK-5348) is a potent and orally active thrombin receptor (PAR-1) antagonist with Ki of 8.1 nM.

Related Targets

PAR