Method for prognosis

Abstract

The invention relates to a method for prognosing ACS in a subject, the method comprising determining plasma MIF and Nt-proBNP (or BNP) concentrations in a sample from the subject, diagnosing ACS when the subject plasma concentrations are greater than a reference MIF and Nt-proBNP (or BNP) plasma concentration, and prognosing the magnitude of ACS from the subject plasma MIF and Nt-proBNP (or BNP) concentrations. Also provided is a method of treating ACS in a subject, a device, a kit, and a cardiac biomarker related to the methods of prognosing ACS.

1 . A method of treating acute coronary syndrome (ACS) in a subject, the method comprising:
 determining the concentration of macrophage migration inhibitory factor (MIF) or a fragment thereof in a sample from the subject, wherein the sample is blood, plasma or serum,   wherein if the concentration of MIF or fragment thereof from the sample from the subject is equal to or higher than 70 ng/ml the subject is determined to have a decreased probability of survival and an increased probability of non-fatal cardiac events at a later time,   wherein if the concentration of MIF or fragment thereof from the sample from the subject is lower than 70 ng/ml the subject is determined to have an increased probability of survival and a decreased probability of non-fatal cardiac events at a later time, and   performing percutaneous coronary intervention (PCI) and/or fibrinolysis on the subject when the concentration of MIF from the sample is equal to or higher than 70 ng/ml,   
       thereby treating the subject having ACS. 
     
     
         2 . The method according to  claim 1 , further comprising:
 comparing the concentration of MIF or fragment thereof to reference MIF concentrations of 40 ng/ml and 70 ng/ml,   wherein if the concentration of MIF or fragment thereof from the sample from the subject is equal to or lower than 40 ng/ml the subject is determined to have a high probability of survival and a low probability of non-fatal cardiac events at a later time,   wherein if the concentration of MIF or fragment thereof from the sample from the subject is equal to or higher than 70 ng/ml the subject is determined to have a low probability of survival and a high probability of non-fatal cardiac events at a later time, and   performing percutaneous coronary intervention (PCI) and/or fibrinolysis on the subject when the concentration of MIF from the sample is equal to or higher than thereby treating the subject having ACS.   
     
     
         3 . A method of treating acute coronary syndrome (ACS) in a subject, the method comprising:
 determining the concentration of macrophage migration inhibitory factor (MIF) or a fragment thereof in a sample from the subject, wherein the sample is blood, plasma or serum,   wherein if the concentration of MIF or fragment thereof from the sample from the subject is equal to or higher than 73 ng/ml the subject is determined to have a decreased probability of survival and an increased probability of non-fatal cardiac events at a later time,   wherein if the concentration of MIF or fragment thereof from the sample from the subject is lower than 73 ng/ml the subject is determined to have an increased probability of survival and a decreased probability of non-fatal cardiac events at a later time, and   performing percutaneous coronary intervention (PCI) and/or fibrinolysis on the subject when the concentration of MIF from the sample is equal to or higher than 73 ng/ml,   
       thereby treating the subject having ACS. 
     
     
         4 . The method according to  claim 3 , further comprising determining the concentration of N-terminal prohormone of brain natriuretic peptide (Nt-proBNP) or a fragment thereof. 
     
     
         5 . The method according to  claim 4 , wherein instead of the concentration of N-terminal prohormone of brain natriuretic peptide (Nt-proBNP), the concentration of brain natriuretic peptide (BNP) is determined. 
     
     
         6 . The method according to  claim 4 , wherein if the concentration of Nt-proBNP (or BNP) from the sample from the subject is equal to or higher than 700 pg/ml the subject is determined to have a decreased probability of survival and an increased probability of non-fatal cardiac events at a later time,
 wherein if the concentration of Nt-proBNP (or BNP) from the sample from the subject is lower than 700 pg/ml the subject is determined to have an increased probability of survival and a decreased probability of non-fatal cardiac events at a later time,   performing percutaneous coronary intervention (PCI) and/or fibrinolysis on the subject when the concentration of Nt-proBNP (or BNP) from the sample is equal to or higher than 700 pg/ml,   
       thereby treating the subject having ACS. 
     
     
         7 . The method according to  claim 4 , wherein if the concentration of Nt-proBNP (or BNP) from the sample from the subject is equal to or higher than 1200 pg/ml the subject is determined to have a decreased probability of survival and an increased probability of non-fatal cardiac events at a later time,
 wherein if the concentration of Nt-proBNP (or BNP) from the sample from the subject is lower than 1200 pg/ml the subject is determined to have an increased probability of survival and a decreased probability of non-fatal cardiac events at a later time,   performing percutaneous coronary intervention (PCI) and/or fibrinolysis on the subject when the concentration of Nt-proBNP (or BNP) from the sample is equal to or higher than 1200 pg/ml,   
       thereby treating the subject having ACS. 
     
     
         8 . The method according to  claim 4 , further comprising determining the concentration of troponin or a fragment thereof. 
     
     
         9 . The method according to  claim 8 , wherein the troponin is high sensitive-troponin T (hs-TnT). 
     
     
         10 . The method according to  claim 8 , wherein if the concentration of troponin from the sample from the subject is equal to or higher than 4.5 ng/ml the subject is determined to have a decreased probability of survival and an increased probability of non-fatal cardiac events at a later time,
 wherein if the concentration of troponin from the sample from the subject is lower than 4.5 ng/ml the subject is determined to have an increased probability of survival and a decreased probability of non-fatal cardiac events at a later time,   performing percutaneous coronary intervention (PCI) and/or fibrinolysis on the subject when the concentration of troponin from the sample is equal to or higher than 4.5 ng/ml,   
       thereby treating the subject having ACS. 
     
     
         11 . The method according to  claim 8 , wherein the concentrations of MIF, Nt-proBNP and/or troponin or fragments thereof are determined from plasma. 
     
     
         12 . The method according to  claim 3 , wherein ACS is acute myocardial infarction (AMI). 
     
     
         13 . The method according to  claim 12 , wherein the AMI is ST elevation myocardial infarction (STEMI). 
     
     
         14 . The method according to  claim 3 , comprising determining MIF concentration of the subject in a sample taken less than 4 hours after symptom onset. 
     
     
         15 . The method according to  claim 14 , wherein the sample is taken 3 hours or less, 2 hours or less, 1 hour or less, or 30 minutes or less after symptom onset. 
     
     
         16 . The method according to  claim 3 , wherein the survival is MACE-Free survival, All-cause mortality free survival, cardiac death free survival or HF rehospitalisation free survival. 
     
     
         17 . The method according to  claim 4 , wherein Nt-proBNP (or BNP) and MIF are measured in the same sample. 
     
     
         18 . The method according to  claim 11 , wherein the concentration of BNP is determined in plasma derived from a blood sample obtained from a patient 3 days following symptom onset. 
     
     
         19 . The method according to  claim 3 , further comprising determining the concentration of another biomarker selected from the group consisting of myoglobin, creatine kinase (CK) and C reactive protein (CRP).