Multimarker Approaches Using Three Or More Markers Proof of Concept Crp Bnp and Troponin

Given the evidence for the independent prognostic value ofthe three widely available, conveniently measured biomarkers CRP, BNP, and troponin, my colleagues and I explored

: Elevated Cardiac Biomarkers

Fig. 6. Relative risk (RR) of death at 30 d using multimarker strategy in which patients are stratified by number of elevated biomarkers among a panel of cTnl, BNP, and hsCRP applied among patients enrolled in TACTICS-TIMI 18 Trial. (Data are from ref. 38.)

: Elevated Cardiac Biomarkers

Fig. 6. Relative risk (RR) of death at 30 d using multimarker strategy in which patients are stratified by number of elevated biomarkers among a panel of cTnl, BNP, and hsCRP applied among patients enrolled in TACTICS-TIMI 18 Trial. (Data are from ref. 38.)

Fig. 7. RR of composite end point of death, MI, or new CHF at 30 d and 6 mo of follow-up in TACTICS-TIMI 18 stratified using combination of cTnl, BNP, and hsCRP. (Data are from ref. 38.)

the hypothesis that application of multiple pathobiologically distinct markers would offer complementary information for assessment of risk among patients presenting with ACS. Using a simple strategy combining BNP, CRP, and cTnI and assigning one point for each elevated marker, we found that a multimarker approach enhanced risk stratification, establishing a more than 10-fold gradient ofmortality risk among 1635 patients with NSTEACS (Fig. 6) (38). This strategy was consistent with respect to risk prediction at 30 d and 610 mo, as well as across two independent data sets (Fig. 7). Although the risk relationships were not entirely homogeneous, a graded pattern of risk was present for the individual end points of death, MI, and heart failure (Table 1). After adjustment for age, diabetes, ST-deviation, history of heart failure, and prior MI, each multimarker category (one, two, or three markers elevated) was independently associated with the risk of death, MI, or new heart failure at 6 mo (Fig. 8). These observations provided an important proof

Table 1

RR of Clinical Events Using Multimarker Strategy "

Table 1

RR of Clinical Events Using Multimarker Strategy "

End pointb

No. of elevated biomarkers (cTnI, BNP, hsCRP)

p Value

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