# Combined point-of-care biomarkers for risk stratification in patients with non-ST-elevation acute coronary syndrome in the emergency department

## TL;DR

A new model using three biomarkers improves risk prediction for older patients with heart issues in emergency settings.

## Contribution

A combined point-of-care testing model with three biomarkers outperforms the GRACE risk score for predicting cardiovascular events.

## Key findings

- Elevated NT-proBNP, D-dimer, and hs-CRP each independently predict major adverse cardiovascular events.
- The three-marker model had a higher predictive accuracy (AUC 0.958) than the GRACE risk score (AUC 0.822).
- MACE incidence increased with the number of positive biomarkers, reaching 86.96% with all three elevated.

## Abstract

Risk stratification is crucial for patients aged ≥60 years with non-ST-elevation acute coronary syndrome (NSTE-ACS). Although the Global Registry of Acute Coronary Events (GRACE) risk score is commonly used, it may be less practical in the emergency setting. This study aimed to evaluate whether a combined point-of-care testing (CM-POCT) model using three biomarkers could effectively predict major adverse cardiovascular events (MACE).

This retrospective study included 117 patients aged ≥60 years with NSTE-ACS presenting to the emergency department. Point-of-care testing for NT-proBNP, D-dimer, and hs-CRP was performed within 6 h of symptom onset. Independent risk factors were identified, and the predictive value of the three-marker CM-POCT model was compared with the GRACE risk score using receiver operating characteristic curve analysis.

Among the 117 participants (mean age 72.2 ± 8.0 years), 27 experienced MACE. Elevated levels of NT-proBNP (≥2,410 pg/mL), D-dimer (≥0.54 µg/mL), and hs-CRP (≥5.58 µg/mL) were each independent predictors of MACE (all P < 0.05). The incidence of MACE increased progressively with the number of elevated markers from 0.0% (no positive markers) to 3.45% (one positive marker), 40.0% (two positive markers), and 86.96% (three positive markers). The area under the curve (AUC) of the three-marker CM-POCT model was 0.958 (95% CI: 0.923–0.993), significantly higher than the GRACE risk score (AUC: 0.822; 95% CI: 0.730–0.913; P = 0.003).

The three-marker CM-POCT model could be a more efficient tool for early risk stratification in patients aged ≥60 years with NSTE-ACS in emergency settings. The risk of MACE increases significantly with the number of positive markers.