Multiple biomarkers improve prognostication for long-term mortality in ST-segment elevation myocardial infarction (STEMI). However, one-third of mortality after STEMI occurs within initial discharge. Our objective was to determine whether multiple biomarkers (glucose, N-terminal pro-brain natriuretic peptide (NT-proBNP), and estimated glomerular filtration rate (eGFR)) predict both short-term as long-term mortality in STEMI. We used a patient-pooled dataset of consecutive STEMI patients, with complete biomarkers, who underwent primary percutaneous coronary intervention (PCI) in two single centers (Amsterdam and Groningen). With a previously developed multimarker risk score, based on three biomarkers, patients were indicated as low-, intermediate- or high risk. Cumulative 4-year mortality was estimated with the Kaplan-Meier method and compared with a log-rank test. We compared short-term and long-term mortality with a landmark set at 30 days because previous studies have shown that mortality largely occurs within 30 days. A total of 2,355 STEMI-patients were treated with primary PCI. The mortality rates in the low- (n = 1,531), intermediate- (n = 403) and high-risk (n = 421) groups were 4.8, 16.1, and 43.9 %, respectively. The differences were observed at a follow-up up to 30 days (log-rank p < 0.001) as well as after 30 days (log-rank p < 0.001). A multimarker risk score, based on admission levels of glucose, NT-proBNP, and eGFR identifies STEMI patients at low-, intermediate-, and high-risk for short-term and long-term mortality.

译文

多种生物标志物可改善ST段抬高型心肌梗死 (STEMI) 长期死亡率的预后。然而,STEMI后的死亡率3分之1发生在初始放电中。我们的目标是确定多种生物标志物 (葡萄糖,N末端脑钠肽前体 (NT-proBNP) 和估计的肾小球滤过率 (eGFR)) 是否预测STEMI的短期长期死亡率。我们使用了在两个单一中心 (阿姆斯特丹和格罗宁根) 接受初次经皮冠状动脉介入治疗 (PCI) 的具有完整生物标志物的连续STEMI患者的患者汇总数据集。根据先前开发的基于三种生物标志物的多标记风险评分,患者被指示为低,中或高风险。使用Kaplan-Meier方法估算了4年的累积死亡率,并与log-rank检验进行了比较。我们将短期和长期死亡率与设定为30天的里程碑进行了比较,因为先前的研究表明死亡率主要发生在30天内。共有2,355例STEMI患者接受了原发性PCI治疗。低 (n = 1,531),中 (n = 403) 和高危 (n = 421) 组的死亡率分别为4.8,16.1和43.9%。在随访30天 (log-rank p < 0.001) 以及30天后 (log-rank p < 0.001) 观察到差异。基于血糖,NT-proBNP和eGFR的入院水平的多标记风险评分可识别STEMI患者处于短期和长期死亡率的低,中和高风险。

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