Cardiac markers and risk stratification: an integrated approach

Risk stratification of patients with acute coronary syndromes (ACS) is pivo tal for correct allocation of health resources and for maximizing the benef it of available treatment modalities. However, clinical and electrocardiogr aphic indicators of high risk lack sufficient sensitivity for the detection of major cardiac events. The complementary information provided by the mea surement of different biomarkers is believed to be very useful. Specificall y, elevations of cardiac troponin I (cTnI) and T (cTnT) are strongly associ ated with a high-risk profile both at short- and long-term. This has been d efinitely demonstrated in many studies as well as in cumulative meta-analys is. The role of different biomarkers, such as those reflecting activation o f hemostasis and the presence of inflammation, is however less defined. At the moment, no study has prospectively evaluated these biomarkers in the wh ole spectrum of unselected patients with ACS. It is also unclear whether th ese biomarkers add independent prognostic value to the clinical and electro cardiographic indicators of adverse outcome and whether they offer addition al information when compared to each other. The Early Prognostic Value of B iochemical Markers of Myocardial Damage, Activation of Hemostatic Mechanism and Inflammation in Acute Ischemic Syndromes (EMAI) study has been prospec tively designed to solve these issues. In this study, we have evaluated the prognostic value of cTnI and cTnT, D-dimer, prothrombin fragment 1 + 2 (F1 + 2), thrombin-antithrombin complex (TAT) and C-reactive protein (CRP) in patients with ACS at the time of admission. We have enrolled in 31 Italian Coronary Care Units 1971 patients with rest anginal pain within 12 h from a dmission and electrocardiographic evidence of myocardial ischemia. Of these , 730 patients resulted to have ST-segment elevation myocardial infarction eligible for a reperfusion strategy and 1241, an acute coronary syndrome wi thout persisting ST-segment elevation. Primary outcome measure of the study is the composite of death and non-fatal MI within 30 days from admission, which has occurred in 8.9% of the study population. (C) 2001 Elsevier Scien ce B.V. All rights reserved.