Title : Biomarkers guided therapy for risk stratification and prognostication of patients treated for Acute Coronary Syndrome
There are cumulating evidences of prognostic implications of cardiac biomarkers in patients with acute coronary syndrome (ACS). The prognostic role of troponin (hsTn), natriuretic peptides (NPs), stress glycaemia, HbA1c, are described in different extent in the current trials. There are also data that demonstrates NPs to be predictors not only of heart failure development, but also of recurrent ischemic events.
The aim of our study is to evaluate the role of cardiac biomarkers in ACS patients in differential prognostication of heart failure (HF) versus ischemic events in correlation with left ventricular systolic function: reduced, mid-range and preserved at the index event point.
Material and methods: 200 patients treated for ACS with PCI revascularization are included in the study. Beside clinical data, biomarkers such as: stress glycaemia, fasting blood glycose (FBG), HbA1c, hsTn, NT-proBNP, creatinin, estimated glomerular filtration rate (eGFR), blood urea (BUN), are measured at index event and at three months. Also, echocardiography at index event and after 3 months is/will be performed to classify patients with ACS, as having reduced, mid-range and/or preserved LVEF, and to identify transition of patients (especially those from mid-range EF group). Planned follow-up period is one year from the index event.
Results: preliminary data of ongoing study identifies cardiac troponins, stress glycaemia, HbA1c as predictors of short and mid-term prognosis in patients with ACS. With respect to NPs, our preliminary data suggests prognostic role of NPs in prediction of heart failure (after correction for eGFR), but also possible role in prediction of recurrent ischemic events more significantly in patients with mid-range LVEF.
Conclusion: this data suggests that prognostic models that incorporates simple biomarkers and estimated LVEF at index event and after three months can be developed to identify patients with differential risk of HF versus recurrent ischaemic events.