The prognostic value of neurohormonal and inflammatory biomarkers in addition to the TIMI risk score in patients with ST-elevation myocardial infarction

Background: The Thrombolysis in Myocardial Infarction (TIMI) risk score estimates mortality for patients with ST-elevation myocardial infarction (STEMI). This study aimed to investigate whether biomarkers reflecting the neurohormonal response (pro-atrial natriuretic peptide (proANP), mid-regional pro-adrenomedullin (MR-proADM), and copeptin), inflammation (suppression of tumorigenicity 2 (ST2), C-reactive protein (CRP), and leukocytes), and troponin add prognostic value to the TIMI risk score.

Methods: This sub-study of the prospective PREDICT cohort included 1700 non-comatose and non-cardiogenic shock STEMI patients upon admission. Blood samples were collected before coronary angiography. Biomarker quartiles (Q4vsQ1-3) association with 30-day mortality were examined using Cox proportional hazard models.

Results: High levels of all biomarkers were associated with 30-day mortality independently of TIMI risk score, hazard ratio (HR)_Q4vsQ1-3 (95%CI), MR-proADM: 8.8 (3.9-20), proANP: 3.5 (1.8-6.7), copeptin: 1.9 (1.1-3.5), ST2: 4.5 (2.3-8.6), CRP: 2.6 (1.3-4.9), and leukocyte: 2.18 (1.2;4.0). TIMI risk score had a high prognostic value, AUC(95%CI): 0.76 (0.69-0.83). Only MR-proADM, proANP, CRP, ST2, and TnT added prognostic value to the risk score, 0.84 (0.77-0.91), 0.80 (0.74-0.87), 0.78 (0.71-0.86), 0.81 (0.73-0.88), and 0.79 (0.71-0.87), respectively. However, MR-proADM demonstrated a higher prognostic value on its own (0.86 (0.80-0.91)).

Conclusion: TIMI risk score and all the biomarkers added prognostic values of 30-day mortality. The strongest predictor of 30-day mortality was observed for MR-proADM alone.