Table 1 |
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shows an overview of different biomarkers that have been tested in ACS, organized by major pathophysiologic mechanism. |
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Main mechanism |
Biomarker (ref) |
Population tested |
Risk prediction |
|
Inflammation |
asymptomatic subjects n = 1492 ACS population of Frisc trial |
RR = 1.79 for CRP > 3.0 mg/L RR = 3.40 for CRP > 10.0 mg/L |
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ACS patients n = 43 ACS patients of Frisc II trial n = 3269 |
OR = 7 for in-hosptial events RR = 3.47 (12 month mortality) for the non-invasive group RR = 1.43 for the invasive group Asymptomatic:RR 1.31 ACS > RR 3.5 |
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IL1 [29] |
ACS patients n = 43 |
OR = 11 for in hospital events |
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MCP1 [31] |
ACS n = 2270 (OPUS-TIMI16) control n = 227 |
HR = 1.53 for death or non-fatal MI after 10 months |
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IL18 [32] |
n = 1229 stable/instable patients CAG reffered |
HR = 3.3 for cardiovascular death in the highest vs. the lowest quartile |
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IL 10 [33] |
ACS n = 547 CAPTURE study |
HR = 0.38 for death or non-fatal MI after 6 months |
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SAA [34] |
ACS n = 435 |
RR = 9.7 for 14 day mortality (quintile 5 vs quintiles 1–4) |
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ACS n = 965 ACS n = 985 FRISC trial |
RR = 1.35 for death or non fatal MI after 6 months RR = 2.6 for cardiac death after 2 years |
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Fibrinogen [24] |
ACS n = 985 FRISC trial |
RR = 1.99 for cardiac death after 2 years |
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ICAM |
elective coronary angiography n = 1246 ACS n = 91 vs control n = 24 ACS n = 114 |
higher in cardiovascular death, not an independent predictor |
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VCAM |
elective coronary angiography n = 1246 ACS n = 91, vs control n = 24 ACS n = 114 |
RR = 2.8 for cardiovascular events after 2.7 years Higher levels up till 6 months after ACS. Levels higher in patients with MACE OR = 4.3 for MACE (highest vs. lowest quartile) |
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elective coronary angiography n = 1246 ACS n = 91 vs control n = 24 ACS n = 114 |
higher in cardiovascular death, not an independent predictor |
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PlGF [39] |
UAP n = 544 |
OR = 3.3 for death median FU 4 years |
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Oxidative stress |
chest pain n = 604 ACS n = 1090 |
4th quartile OR = 4.1 for MACE at 6 months HR = 2.11 for death/MI at 6 months |
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sPLA2 [42] |
ACS n = 446 |
HR = 3.08 for death/MI |
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Lp(a) [43] |
CAG patients n = 504 |
RR = 2.47 for the presence of obstructive CAD |
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Fibrous cap degradation |
MMP2 [44] |
ACS n = 33, SAP n = 17, control n = 17 |
serial elevation 2× normal value in ACS during 1 week |
|
MMP 9 [44] |
ACS n = 33, SAP n = 17, control n = 17 |
serial elevation 2× normal value in ACS during 1 week |
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ACS n = 37 SAP n = 19 control n = 13 ACS n = 547 Chest pain n = 644 |
Higher levels in ACS versus SAP/control OR = 2.44 for 30 day death/MI OR = 2.32 for 30 day death/MI |
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Coagulation or trombocyt aggregation |
STEMI n = 153 STEMI n = 86 314 STEMI |
vWF release higher in cardiovascular death vWF release OR 6.1 for 14 day composite endpointOR = 2.0 for 30 day maortality/MI (highest quartile vs quartiles 1–3) |
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[49] |
ACS 544 chest pain patients n = 626 |
OR = 2.71 for death/MI at 6 months OR = 6.65 |
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Ischemia |
IMA [50] |
ACS n = 256) |
negative predictive value = 96% |
|
FFA [51] |
scheduled PCI n = 22 |
Correct prediction of ECG/troponin findings post procedure |
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Choline [52] |
suspected ACS n = 327 |
HR = 6.05 for cardiac death/non-fatal arrest in troponin negative group |
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chest pain n = 48 chest pain n = 107 |
Better prediction than CK-MB |
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ACS n = 1791 FRISC I ACS n = 2019 FRISC II |
OR = 3.7 for death and non-fatal MI after 30 days HR = 4.1 for mortality after 2 years in non-invasive group OR = 1.55 with every standard deviation rise |
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CRP = (high sensitivity) C-Reactive Protein; IL6 = interleukin6; IL1 = interleukin1; MCP1= monocyte chemoattractant protein-1; IL18 = interleukin18; IL10 = interleukin10; SAA = Serum amyloid A; ICAM = intercellular adhesion molecule-1; VCAM = Vascular cell adhesion molecule-1; PlGF = Placental Growth Factor; MPO = myeloperoxidase; sPLA2 = Circulating secretory phospholipase A2 activity; Lp(a) = Lp(a) lipoprotein; MMP2 = matrix metalloproteases-2; MMP9 = matrix metalloproteases-9; PAPP-A = Pregnancy-associated plasma protein A; vWF = von Willebrand factor; NT-proBNP = N-terminal pro-brain natriuretic peptide; FFA = free fatty acids; IMA = Ischemia modified albumin GP-BB = Glycogen phosphorylase isoenzym BB. ACS = acute coronary syndrome; UAP = unstable angina pectoris; SAP = stable angina pectoris. CAG = coronary artery angiogram OR = odds ratio; RR = relative risk; HR = hazard ratio |
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Willemsen et al. BMC Cardiovascular Disorders 2009 9:24 doi:10.1186/1471-2261-9-24 |
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