Multimarker approach predicts adverse cardiovascular events in women evaluated for suspected ischemia: results from the National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation.

Background Inflammatory marker and hemoglobin levels (eg biomarkers) considered separately, predict adverse events in selected populations. Hypothesis A multiple biomarker approach predicts adverse events in women referred for evaluation of ischemia. Methods We investigated associations between biomarkers (high sensitivity C-reactive protein, interleukin-6, serum amyloid-A, and hemoglobin levels) with adverse outcomes in women referred for coronary angiography for suspected ischemia in the National Heart, Lung, and Blood Institute (NHLBI)–sponsored Women's Ischemia Syndrome Evaluation (WISE). Results Among 595 women (mean age 58 years, ejection fraction [EF] 65%, majority without coronary stenosis ≥ 50%) followed for 3.6 ± 1.8 years (mean ± SD), those without abnormal markers had fewer events (11.6%) compared to those with 1 (18.4%), 2 (20.9%), or 3 (37%) abnormal markers (p < 0.001 for trend). Women without abnormal markers had fewer deaths (1.6%) than women with 1 (6.1%), 2 (9.1%), or 3 (17%) abnormal markers (p < 0.001 for trend). Adding low hemoglobin was associated with higher adverse event and all-cause mortality rates. In multivariate analysis, as the number of abnormal biomarkers increased risk increased. Women with 3 or 4 abnormal biomarkers were approximately 10–20 times more likely to die (p < 0.05). Biomarkers added to the predictive information provided by the Framingham Risk Score. Conclusions Among women undergoing coronary angiography for suspected ischemia, a multibiomarker approach predicted adverse events. Biomarkers added prognostic information beyond that obtained from traditional risk factors. Copyright © 2009 Wiley Periodicals, Inc.