Cohort profile of BIOMArCS: the BIOMarker study to identify the Acute risk of a Coronary Syndrome-a prospective multicentre biomarker study conducted in the Netherlands

Rohit M. Oemrawsingh, K. Martijn Akkerhuis, Victor A. Umans, Bas Kietselaer, Carl Schotborgh, Eelko Ronner, Timo Lenderink, Anho Liem, David Haitsma, Pim Van der Harst, Folkert WAsselbergs, Arthur Maas, Anton J. Oude Ophuis, Ben Ilmer, Rene Dijkgraaf, Robbert-Jan De Winter, S. Hong Kie The, Alexander J. Wardeh, Walter Hermans, Etienne CramerRon H. Van Schaik, Imo E. Hoefer, Pieter A. Doevendans, Maarten L. Simoons, Eric Boersma*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Purpose: Progression of stable coronary artery disease (CAD) towards acute coronary syndrome (ACS) is a dynamic and heterogeneous process with many intertwined constituents, in which a plaque destabilising sequence could lead to ACS within short time frames. Current CAD risk assessment models, however, are not designed to identify increased vulnerability for the occurrence of coronary events within a precise, short time frame at the individual patient level. The BIOMarker study to identify the Acute risk of a Coronary Syndrome (BIOMArCS) was designed to evaluate whether repeated measurements of multiple biomarkers can predict such 'vulnerable periods'. Participants: BIOMArCS is a multicentre, prospective, observational study of 844 patients presenting with ACS, either with or without ST-elevation and at least one additional cardiovascular risk factor. Methods and analysis: We hypothesised that patterns of circulating biomarkers that reflect the various pathophysiological components of CAD, such as distorted lipid metabolism, vascular inflammation, endothelial dysfunction, increased thrombogenicity and ischaemia, diverge in the days to weeks before a coronary event. Divergent biomarker patterns, identified by serial biomarker measurements during 1-year follow-up might then indicate 'vulnerable periods' during which patients with CAD are at high short-term risk of developing an ACS. Venepuncture was performed every fortnight during the first half-year and monthly thereafter. As prespecified, patient enrolment was terminated after the primary end point of cardiovascular death or hospital admission for non-fatal ACS had occurred in 50 patients. A case-cohort design will explore differences in temporal patterns of circulating biomarkers prior to the repeat ACS. Future plans and dissemination: Follow-up and event adjudication have been completed. Prespecified biomarker analyses are currently being performed and dissemination through peer-reviewed publications and conference presentations is expected from the third quarter of 2016. Should identification of a 'vulnerable period' prove to be feasible, then future research could focus on event reduction through pharmacological or mechanical intervention during such periods of high risk for ACS.
Original languageEnglish
Article numbere012929
Number of pages9
JournalBMJ Open
Issue number12
Publication statusPublished - 2016

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