Abstract
Objectives Details of the biological variability of high-sensitivity C-reactive protein (hs-CRP), N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and ST2 are currently lacking in patients with acute coronary syndrome (ACS) but are crucial knowledge when aiming to use these biomarkers for personalized risk prediction. In the current study, we report post-ACS kinetics and the variability of the hs-CRP, NT-proBNP and ST2. Methods BIOMArCS is a prospective, observational study with high frequency blood sampling during 1 year post-ACS. Using 1507 blood samples from 191 patients that remained free from adverse cardiac events, we investigated post-ACS kinetics of hs-CRP, NT-proBNP and ST2. Biological variability was studied using the samples collected between 6 and 12 months after the index ACS, when patients were considered to have stable coronary artery disease. Results On average, hs-CRP rose peaked at day 2 and rose well above the reference value. ST2 peaked immediately after the ACS but never rose above the reference value. NT-proBNP level rose on average during the first 2 days post-ACS and slowly declined afterwards. The within-subject variation and relative change value (RCV) of ST2 were relatively small (13.8%, RCV 39.7%), while hs-CRP (41.9%, lognormal RCV 206.1/-67.3%) and NT-proBNP (39.0%, lognormal RCV 185.2/-64.9%) showed a considerable variation. Conclusions Variability of hs-CRP and NT-proBNP within asymptomatic and clinically stable post-ACS patients is considerable. In contrast, within-patient variability of ST2 is low. Given the low within-subject variation, ST2 might be the most useful biomarker for personalizing risk prediction in stable post-ACS patients.
Highlights
Elevated serum levels of high-sensitivity C-reactive protein, N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and soluble ST2 (ST2) have been associated with adverse cardiovascular events in patientsFolkert W
Details of the biological variability of highsensitivity C-reactive protein, N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and ST2 are currently lacking in patients with acute coronary syndrome (ACS) but are crucial knowledge when aiming to use these biomarkers for personalized risk prediction
We report post-ACS kinetics and the variability of the highsensitivity C-reactive protein (hs-C-reactive protein (CRP)), NT-proBNP and ST2
Summary
Elevated serum levels of high-sensitivity C-reactive protein (hs-CRP), N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and soluble ST2 (ST2) have been associated with adverse cardiovascular events in patientsFolkert W. Elevated serum levels of high-sensitivity C-reactive protein (hs-CRP), N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and soluble ST2 (ST2) have been associated with adverse cardiovascular events in patients. Asselbergs: Netherlands Heart Institute, Utrecht, The Netherlands; and University Medical Center Utrecht, Utrecht, The Netherlands Pim van der Harst: Netherlands Heart Institute, Utrecht, The Netherlands; and University Medical Center Groningen, Groningen, The Netherlands Imo E. Hoefer: University Medical Center Utrecht, Utrecht, The Netherlands Bas Kietselaer and Timo Lenderink: Zuyderland Hospital, Heerlen, The Netherlands Harry J.G.M. Crijns: Maastricht University Medical Center, Maastricht, The Netherlands Anton J. Oude Ophuis: Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands; and Working Group on Cardiovascular Research the Netherlands (WCN), Utrecht, The Netherlands. The differences in serum levels between the patients with and without cardiovascular events are often not large. In a study by Zebrack et al among 2554 patients undergoing coronary angiography, in the group without CAD and the lowest event rate during a mean follow-up of 2 years median CRP levels was from 1.15 mg/dL, compared median levels of 1.28 mg/dL in the group with the most severe CAD and highest event rate during follow-up [4]
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