TY  - BOOK
AU  - Epstein, Stephen E
TI  - Aggregate risk score based on markers of inflammation, cell stress, and coagulation is an independent predictor of adverse cardiovascular outcomes
SN  - 0735-1097
KW  - *C-Reactive Protein/me [Metabolism]
KW  - *Cardiovascular Diseases/me [Metabolism]
KW  - *Cardiovascular Diseases/pa [Pathology]
KW  - *Coronary Artery Disease/me [Metabolism]
KW  - *Coronary Artery Disease/pa [Pathology]
KW  - *Fibrin Fibrinogen Degradation Products/me [Metabolism]
KW  - *HSP70 Heat-Shock Proteins/me [Metabolism]
KW  - *Severity of Illness Index
KW  - Aged
KW  - Biological Markers/bl [Blood]
KW  - Cardiovascular Diseases/mo [Mortality]
KW  - Cohort Studies
KW  - Coronary Artery Disease/mo [Mortality]
KW  - Female
KW  - Follow-Up Studies
KW  - Humans
KW  - Inflammation/me [Metabolism]
KW  - Inflammation/mo [Mortality]
KW  - Inflammation/pa [Pathology]
KW  - Male
KW  - Middle Aged
KW  - Predictive Value of Tests
KW  - Risk Factors
KW  - MedStar Health Research Institute
KW  - Journal Article
N1  - Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007
N2  - BACKGROUND: Activation of inflammatory, coagulation, and cellular stress pathways contribute to atherosclerotic plaque rupture.We hypothesized that an aggregate risk score comprised of biomarkers involved in these different pathways-high-sensitivity C-reactive protein (CRP), fibrin degradation products (FDP), and heat shock protein 70(HSP70) levels-would be a powerful predictor of death and MI; CONCLUSIONS: An aggregate score based on serum levels of CRP, FDP, and HSP70 is a predictor of future risk of death and MI inpatients with suspected or known CAD. Copyright  2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved; METHODS: Serum levels of CRP, FDP, and HSP70 were measured in 3,415 consecutive patients with suspected or confirmed coronary artery disease (CAD) undergoing cardiac catheterization. Survival analyses were performed with models adjusted for established risk factors; OBJECTIVES: This study sought to determine an aggregate, pathway-specific risk score for enhanced prediction of deathand myocardial infarction (MI); RESULTS: Median follow-up was 2.3 years. Hazard ratios (HRs) for all-cause death and MI based on cutpoints were as follows: CRP>=3.0 mg/l, HR: 1.61; HSP70 >0.625 ng/ml, HR; 2.26; and FDP>=1.0 mug/ml, HR: 1.62 (p< 0.0001 for all). Anaggregate biomarker score between 0 and 3 was calculated based on these cutpoints. Compared with the groupwith a 0 score, HRs for all-cause death and MI were 1.83, 3.46, and 4.99 for those with scores of 1, 2, and 3, respectively (p for each:<0.001). Annual event rates were 16.3% for the 4.2% of patients with a score of 3 compared with 2.4% in 36.4% of patients with a score of 0. The C statistic and net reclassification improved (p<0.0001) with the addition of the biomarker score
UR  - http://dx.doi.org/10.1016/j.jacc.2013.03.072
ER  -