Risk stratification of myocardial infarction using cardiac peptides

We investigated the TIMI risk score, Cardiotrophin-1 (CT-1) myotrophin and MPO in combination with NTproBNP at predicting adverse outcome following AMI. We recruited 596 patients with AMI. Patients were TIMI risk scored. The concentrations of CT-1, myotrophin, MPO and NTproBNP were measured using non-competitive immunoassays. All patients were followed-up for death, recurrent MI, heart failure (HF) and MACE (death, MI and need for urgent revascularisation). Mortality was related to higher TIMI score (p=0.029) and NTproBNP levels (<0.0001). NTproBNP was an independent predictor of mortality (OR 4.21). The receiver-operating curve (ROC) area under curve (AUC) for NTproBNP was greater than TIMI risk score (0.79 vs. 0.67). CT-1 was raised in death or HF (0.77 vs. 0.73fmol/ml; p=0.001). In multivariate analysis CT-1 (HR 1.5) and NTproBNP (HR2.1) predicted death or HF independently of clinical factors. The ROC AUC for CT-1 was 0.62; NTproBNP was 0.77; AUC for combined markers was 0.84. Myotrophin was raised in patients with death, death or HF and MACE. In Cox analysis myotrophin (HR 5.07) and NTproBNP (HR 7.15) independently predicted death. Myotrophin was better at predicting death or HF (HR 2.35) and MACE (HR 1.69). Median MPO was raised in patients experiencing death, death or MI, death or HF and MACE. In Cox analysis median MPO predicted death (HR 13.05) and death or non-fatal MI (HR 5.07). A multimarker approach with NTproBNP may be useful for risk stratification in AMI patients.