Biomarkers predict prognosis in patients with chest pain

Øistein Rønneberg Mjelva‘s PhD research indicates that B-type natriuretic peptide (BNP) should be routinely measured in patients with acute chest pain of suspected cardiac origin.


MAIN RESULTS:

  1. In chest pain patients with suspected acute coronary syndrome, high levels of pentraxin-3 (PTX3), D-dimer and BNP were independently associated with long-term mortality.
  2. BNP and high-sensitive C-reactive protein (hsCRP) also predicted myocardial infarction in the same patient group.
  3. Fibrinogen and neopterin predict future myocardial infarction in patients with stable coronary heart disease.


THESIS DEFENCE:

Thesis: Cardiovascular biomarkers as prognostic indicators in coronary chest pain patients
Candidate: Øistein Rønneberg Mjelva
Time: October 12, 2017 at 10:30
Place: Stavanger University Hospital, South Building: Aula, 2nd floor
Link to university website (in Norwegian)


SUMMARY:

(1) The RACS study included 871 patients that arrived at Stavanger University Hospital with acute chest pain of suspected cardiac origin during 2002 and 2003. Within seven years, 332 of the patients had died. BNP proved to be the strongest prognostic biomarker to predict both long-term mortality and myocardial infarction. The researchers argue that BNP should be measured routinely in addition to troponins in this group of patients.

Furthermore, Mjelva and co-workers showed that higher plasma levels of both PTX3 and D-dimer could identify the patients with the highest mortality risk. PTX3 is an early marker of inflammation in the vessel walls, and D-dimer is a marker of thrombosis. hsCRP was not an independent predictor of mortality in this study, but higher levels associated with increased risk of future myocardial infarction.

(2) In another study, the researchers included a total of 3525 patients with stable coronary artery disease, of whom 580 had an acute myocardial infarction during the next seven years. High levels of fibrinogen and neopterin predicted future infarctions. Neopterin is a specific inflammatory marker of immune activation, and fibrinogen is a marker of thrombosis.


REFERENCES:

(1) Mjelva, Ø. R., Pönitz, V., Brügger-Andersen, T., Grundt, H., Staines, H., & Nilsen, D. W. (2016). Long-term prognostic utility of pentraxin 3 and D-dimer as compared to high-sensitivity C-reactive protein and B-type natriuretic peptide in suspected acute coronary syndromeEuropean journal of preventive cardiology23(11), 1130-1140.

(2) To be published.