Acute coronary syndrome (ACS) without standard modifiable cardiovascular risk factors (SMuRFs) represents a special case of ACS. Multiple biomarkers have been shown to improve risk stratification in patients with ACS. However, the utility of biomarkers for prognostic stratification in patients with ACS without SMuRFs remains uncertain. The aim of the present study was to evaluate the prognostic value of various biomarkers in patents with ACS without SMuRFs.

Data of consecutive patients with ACS without SMuRFs who underwent coronary angiography in Tianjin Chest Hospital between January 2014 and December 2017 were retrospectively collected. The primary outcome was the occurrence of major adverse cardiovascular event (MACE), defined as a composite of cardiovascular death, myocardial infarction and stroke. Seven candidate biomarkers analyses were analyzed using models adjusted for established risk factors.

During a median 5-year follow-up, 81 of the 621 patients experienced a MACE. After adjustment for important covariates, elevated fibrinogen, D-dimer, N-terminal proB-type natriuretic peptide (NT-proBNP), and lipoprotein (a) [Lp(a)] were found to be individually associated with MACE. However, only D-dimer, NT-proBNP and Lp(a) significantly improved risk reclassification for MACE (all P < 0.05). The multimarker analysis showed that there was a clear increase in the risk of MACE with an increasing number of elevated biomarkers and a higher multimarker score. The adjusted hazard ratio- for MACE (95% confidential intervals) for patients with 4 elevated biomarkers was 6.008 (1.9650–18.367) relative to those without any elevated biomarker-. Adding- the 4 biomarkers or the multimarker score to the basic model significantly improved the C-statistic value, the net reclassification index and the integrated discrimination index (all P < 0.05).

Fibrinogen, D-dimer, NT-proBNP and Lp(a) provided valuable prognostic information for MACE when applied to patients with ACS without SMuRFs. The multimarker strategy, which combined multiple biomarkers reflecting different pathophysiological process with traditional risk factors improved the cardiovascular risk stratification.

没有标准可改变心血管危险因素 (SMuRFs) 的急性冠状动脉综合征 (ACS) 是 ACS 的一个特例。多种生物标志物已被证明可以改善 ACS 患者的风险分层。然而，生物标志物在无 SMuRF 的 ACS 患者预后分层中的效用仍不确定。本研究的目的是评估各种生物标志物在无 SMuRF 的 ACS 患者中的预后价值。

回顾性收集2014年1月至2017年12月天津市胸科医院连续接受冠状动脉造影的无SMuRFs的ACS患者资料。主要结局是主要不良心血管事件（MACE）的发生，定义为心血管死亡、心肌梗死和中风的复合事件。使用针对已建立的风险因素调整的模型分析了七种候选生物标志物分析。

在中位 5 年的随访期间，621 名患者中有 81 名经历了 MACE。在调整重要的协变量后，发现升高的纤维蛋白原、D-二聚体、N 端 proB 型利钠肽 (NT-proBNP) 和脂蛋白 (a) [Lp(a)] 分别与 MACE 相关。然而，只有 D-二聚体、NT-proBNP 和 Lp(a) 显着改善了 MACE 的风险重新分类（所有磷< 0.05)。多标志物分析表明，随着升高的生物标志物数量的增加和更高的多标志物评分，MACE 的风险明显增加。相对于没有任何升高的生物标志物的患者，具有 4 个升高的生物标志物的患者的 MACE（95% 机密区间）的调整后风险比为 6.008（1.9650-18.367）。在基本模型中添加 4 种生物标志物或多标志物评分显着提高了 C 统计值、净重分类指数和综合辨别指数（所有磷< 0.05)。

纤维蛋白原、D-二聚体、NT-proBNP 和 Lp(a) 在应用于没有 SMuRF 的 ACS 患者时为 MACE 提供了有价值的预后信息。多标志物策略将反映不同病理生理过程的多种生物标志物与传统危险因素相结合，改善了心血管危险分层。