| Objective: Non-ST elevation acute coronary syndromes(NSTEACS) is a common clinical syndromes, encompass acontinuum of cardiac ischemic events, ranging from unstableangina(UA) to non-ST elevation myocardial infarction(NSTEMI). The common denominator of non-ST elevationacute coronary syndromes is a pathophysiologic processcharacterized by rupture of atherosclerotic plaque, plateletaggregation and thrombosis, the coronary artery obstructedpartly by acute thrombosis. They are easily developing to STelevation myocardial infarction or sudden death, the prognosisof patients with non-ST elevation acute coronary syndromes areadverse. It is reported that patients with acute coronarysyndromes without ST-segment elevation constitute a high-riskpopulation with a mortality 1 year after the index extent of7%-8%. So more and more clinicians in the field of cardiologyfocus their mind on how to stratify risk more effectively andguide therapeutic decision-making among patients with non-STelevation acute coronary syndromes. Several new cardiacbiomarkers have emerged as strong predictors of risk amongpatients presenting with non-ST elevation acute coronarysyndromes and are now routinely available to clinicians,such asTroponin I (TnI), C-reactive protein (CRP), B-type natriureticpeptide (BNP). As we all know these three biomarkers assessdifferent pathophysiological mechanisms in myocardialischemia: elevations in troponin indicate myocardial necrosis;CRP is a marker of inflammation; and BNP is elevated inresponse to left ventricular overload. Elevated levels of TnI,CRP, BNP each are associated with higher rates of death andrecurrent ischemic events. Little is known, however, about theutility of these biomarkers in combination. The present studymeasured the plasma concentrations in patients with non-STelevation acute coronary syndromes, categorized these patientson the basis of the number of elevated biomarkers at presention,and recorded the adverse events in six months include unstableangina, all-cause mortality, nonfatal MI, heart failure. We areinterested in assessing the multimarker strategy that categorizepatients based on the number of elevated biomarkers (TnI, CRP,and BNP) in risk stratification in patients with non-ST elevationacute coronary syndromes.Methods: Patients who suffered non-ST elevation acutecoronary syndromes were enrolled in this study from January2004 to Octorber 2004, the diagnosis of non-ST elevation acutecoronary syndromes was established on the data of symptom,physical examination, mearurement of creatine kinase (CK),CK-MB and TnI plasma levels, electrocardiographic of 12 leadsand echocardiograpy. Patients were excluded if they had ahistory of old myocardial infarction, serious valvular heartdisease, insufficiency of renal function and insufficiency ofheart function. The patients with cancer and inflammation wereall excluded. The blood sample for TnI, CRP, and BNP wereobtained at the time within 24 hours after the onset of symptoms,The levels of plasma BNP was measured using ELISA, and adecision limit of 30 pg/mL was used. The levels of plasma CRPwas measured using ELISA, and a decision limit of 5 pg/mLwas used. The levels of plasma TnI was measured usingImmulite analyzer, and a decision limit of 1 pg/mL was used.All patients were categorized on the basis of the number ofelevated biomarkers at presention, and follow-up the adverseevents in six months include unstable angina, all-cause mortality,nonfatal MI, heart failure. All statistics were performed withSPSS 11.5 statisticical software. Continuous data weredescribed as means ±SEM, continuous variables between the 4groups were compared with One-Way ANOVA, categoricalvariables between the 4 groups were compared with the χ2 testand Cochran Armitage trend test. Statistical significant wasaccepted as a level of P>0.05.Results: 1 0f the 213 patients with non-ST elevation acutecoronary syndromes enrolled in this study, 192 patients finished6 months of follow-up and had the data available for analysis,categorizing all the 192 patients on the basis of the number ofelevated biomarkers at presention, 23% had elevations in noneof the biomarkers, 36% had an elevation in one of thebiomarkers, 24% had elevations in two of the biomarkers, 16%had elevations in all there of the biomarkers; Clinicalcharacteristics: there were no differents about the sex, age,history of hypertension, diabetes, smoking, hyperlipidemiabetween the four groups (P>0.05). 2 The incidence of adverseevents within six months in the 0, 1, 2 and 3 group are 11.40%,15.70%, 29.80%, 41.90% respectively, statistical significantincreasing trends were observed between the number of elevatedcardiac biomarkers and the incidence of adverse events withinsix months (χ2 =12.46, P<0.01). 3 The incidence of unstableangina within six months in the 0, 1, 2, and 3 group are 4.50%,5.70%, 17.00%, 29.00% respectively, statistical significantincreasing trends were observed between the number of elevatedcardiac biomarkers and the incidence of unstable angina withinsix months(χ2 =12.92, P<0.01). 4 The incidence of myocardialinfarction within six months in the 0, 1, 2 and 3 group are 2.27%,4.28%, 6.38%, 9.68% respectively, a increasing trends wereobserved between the number of elevated cardiac biomarkersand the incidence of myocardial infarction within six months ,however, there was no statistical significant (χ2 =1.16, P>0.05). 5 The incidence of heart failure within six months in the0, 1, 2 and 3 group are 2.27%, 4.28%, 6.38%, 6.45%respectively, a increasing trends were observed between thenumber of elevated cardiac biomarkers and the incidence ofheart failure within six months, however, there was no statisticalsignificant (χ2 =0.75, P>0.05). 6 The incidence of death withinsix months in the 0, 1, 2 and 3 group are 2.27%, 1.43%, 2.13%,...
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