Physicians' Academy for Cardiovascular Education

Prognostic value of repeated biomarker sampling post-ACS

Serially measured high-sensitivity cardiac troponin T, N-terminal-pro-B-type natriuretic peptide, high-sensitivity C-reactive protein, and growth differentiation factor 15 for risk assessment after acute coronary syndrome: the BIOMArCS cohort

Literature - Gürgöze MT, Akkerhuis KM, Oemrawsingh RM, et al. - Eur Heart J Acute Cardiovasc Care. 2023 Apr 25;zuad042 [Online ahead of print]. doi: 10.1093/ehjacc/zuad042

Introduction and methods


For prognostication in ACS, several promising markers have emerged, such as NT-proBNP [1,2], CRP [1,3], and growth differentiation factor 15 (GDF-15) [4]. However, most findings are based on a single measurement at baseline, which did not take into account the dynamics during follow-up and across the clinical disease spectrum.

Aim of the study

The study aim was to explore the prognostic value of 4 serially measured biomarkers (i.e., hs-cTnT, NT-proBNP, hs-CRP, and GDF-15) in a large, real-world cohort of post-ACS patients.


The BIOMArCS (BIOMarker study to identify the Acute risk of a Coronary Syndrome) study is a Dutch, prospective, multicenter, observational study in 844 patients aged >40 years who were hospitalized for ACS (including STEMI, NSTEMI, and unstable angina) with ≥1 additional CV risk factor. During 1 year after the index admission for ACS, patients underwent highly frequent blood sampling (total number of samples: 12,218; median number of samples per patient: 17; IQR: 12–20). The first sample during the acute phase was taken at a median time of 14 days (IQR: 2–31).


The primary endpoint was a composite outcome of CV death or recurrent nonfatal ACS event, including MI or recurrent unstable angina requiring urgent coronary revascularization, during 1-year follow-up.

Main results

Longitudinal evolution of biomarker levels

Association of serially measured biomarker level with prognosis


This analysis of the BIOMArCS study showed that longitudinal levels of hs-cTnT and GDF-15, but not NT-proBNP and hs-CRP, were strong independent prognostic factors of the primary endpoint (i.e., CV death or recurrent nonfatal ACS event) in clinically stabilized post-ACS patients during 1-year follow-up. Prior to the occurrence of the primary endpoint, the GDF-15 level increased steadily, while there appeared to be no prominent divergence in hs-cTnT, NT-proBNP, and hs-CRP levels. The authors therefore concluded that “serial measurements seem most promising for GDF-15 to provide early insight into an upcoming event.”


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Find this article online at Eur Heart J Acute Cardiovasc Care.

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