In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.


This content is past the free consultation date

It is only available to ACCA members, members with an all access option or Fellows of the ESC

It is only available to EACVI Members, members with an all access option or Fellows of the ESC

It is only available to EAPC Members, members with an all access option or Fellows of the ESC

It is only available to EAPCI Members, members with an all access option or Fellows of the ESC

It is only available to EHRA Members, members with an all access option or Fellows of the ESC

It is only available to HFA Members, members with an all access option or Fellows of the ESC

It is only available to ESC Pro members, members with an all access option or Fellows of the ESC

Get your access now Get your access now Get your access now Get your access now Get your access now Get your access now Get your access now
Multiple biomarkers and cause-specific mortality in patients with acute coronary syndromes - Insights from the PLATO biomarker substudy

Session Poster Session 1

Speaker Daniel Lindholm

Congress : ESC Congress

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Acute Coronary Syndromes: Biomarkers
  • Session type : Poster Session
  • FP Number : P823

Authors : D Lindholm (Uppsala,SE), S James (Uppsala,SE), K Gabrysch (Uppsala,SE), RF Storey (Sheffield,GB), A Himmelmann (Gothenburg,SE), CP Cannon (Boston,US), KW Mahaffey (Stanford,US), PG Steg (Paris,FR), C Held (Uppsala,SE), A Siegbahn (Uppsala,SE), L Wallentin (Uppsala,SE)

15 views

Authors:
D. Lindholm1 , S. James1 , K. Gabrysch1 , R.F. Storey2 , A. Himmelmann3 , C.P. Cannon4 , K.W. Mahaffey5 , P.G. Steg6 , C. Held1 , A. Siegbahn7 , L. Wallentin1 , 1Uppsala Clinical Research Center - Uppsala - Sweden , 2University of Sheffield - Sheffield - United Kingdom , 3AstraZeneca Research and Development - Gothenburg - Sweden , 4Brigham and Women's Hospital - Boston - United States of America , 5Stanford University, Stanford Center for Clinical Research - Stanford - United States of America , 6University Paris Diderot - Paris - France , 7Uppsala University - Uppsala - Sweden ,

On behalf: PLATO investigators

Citation:
European Heart Journal ( 2018 ) 39 ( Supplement ), 145-146

Background: In patients with acute coronary syndrome (ACS), there is still a residual mortality at about 5% within a year despite early invasive procedures, dual antiplatelet treatment and other secondary preventive measures. Identifying specific predictors of causes of death during aggressive secondary prevention might enable additional preemptive treatment. We therefore assessed the associations between multiple biomarkers and cause-specific mortality.

Methods: We included 17905 ACS patients who participated in the biomarker substudy of the Platelet inhibition and patient outcomes (PLATO) study (NCT00391872). Troponin (Tn) I and T (high sensitivity assays), N-terminal pro-B-type natriuretic peptide (NT-proBNP), C-reactive protein (CRP), Cystatin-C and Growth-differentiation factor 15 (GDF-15) were measured in samples obtained at entry. The associations between biomarkers and cause-specific mortality were modeled using Cox proportional hazards models adjusted for clinical characteristics.

Results: The causes of death of the 4.7% patients who died during follow-up were: myocardial infarction (MI) 1.9%, sudden death 0.9%, heart failure (HF) 0.4%, bleeding 0.1%, and the remainder from other causes. The top marker for death from MI was GDF-15 followed by NT-proBNP and TnT. For sudden cardiac death and HF, NT-proBNP was by far the strongest predictor followed by CRP for heart failure, and GDF-15 for sudden cardiac death. The only marker showing a trend towards association with death from bleeding was GDF-15.

Conclusion: In patients with ACS treated in accordance with current guidelines a raised risk of cause-specific death is indicated by a higher level of different biomarkers. The risk for fatal re-infarction is best predicted by GDF-15, NT-proBNP and TnT, and sudden cardiac death by NT-proBNP and GDF-15. The risk for death from HF is best predicted by NT-proBNP, CRP and GDF-15, while fatal bleeding could possibly be predicted by GDF-15.

Table 1. Causes of death in relation to upper vs. lower biomarker quartile
All-cause death (4.7%)Death from MI (1.9%)Sudden cardiac death/ Arrhythmia (0.9%)Death from HF (0.4%)Death from bleeding (0.1%)
HR (95% CI)HR (95% CI)HR (95% CI)HR (95% CI)HR (95% CI)
CRP1.73 (1.42–2.10)1.61 (1.18–2.20)1.52 (0.98–2.35)3.61 (1.70–7.68)1.09 (0.36–3.26)
Cystatin C1.70 (1.40–2.07)1.58 (1.17–2.13)1.36 (0.89–2.08)3.07 (1.43–6.62)1.77 (0.58–5.43)
GDF-152.65 (2.17–3.24)2.79 (2.04–3.81)2.02 (1.31–3.11)3.16 (1.46–6.85)4.91 (1.39–17.43)
hs-Troponin I1.24 (1.01–1.52)1.85 (1.32–2.61)0.60 (0.38–0.95)1.59 (0.74–3.44)0.83 (0.26–2.62)
hs-Troponin T1.56 (1.27–1.92)2.24 (1.59–3.15)0.72 (0.46–1.14)1.68 (0.79–3.57)1.14 (0.35–3.66)
NT-proBNP2.96 (2.33–3.76)2.74 (1.89–3.98)3.89 (2.29–6.60)8.20 (2.60–25.88)1.43 (0.43–4.75)

This content is available only to ACCA members, members with an all access option or Fellows of the ESC

This content is available only to EACVI Members, members with an all access option or Fellows of the ESC

This content is available only to EAPC Members, members with an all access option or Fellows of the ESC

This content is available only to EAPCI Members, members with an all access option or Fellows of the ESC

This content is available only to EHRA Members, members with an all access option or Fellows of the ESC

This content is available only to HFA Members, members with an all access option or Fellows of the ESC

This content is available only to ESC Pro members, members with an all access option or Fellows of the ESC



Based on your interests

Three reasons why you should become a member

Become a member now
  • 1Access your congress resources all year-round on the New ESC 365
  • 2Get a discount on your next congress registration
  • 3Continue your professional development with free access to educational tools
Become a member now

Our sponsors

ESC 365 is supported by Bayer, Boehringer Ingelheim, Bristol-Myers Squibb and Pfizer Alliance, and Novartis Pharma AG. The sponsors were not involved in the development of this platform and had no influence on its content.

logo esc

Our mission: To reduce the burden of cardiovascular disease

Who we are