Patient Stratification

After occlusion of the cardiac vessels, myocardial Infarction occurs in different pathological phases consisting of evolving (<6 h), acute (6h-7 days), healing (7-28 days), and healed periods (29 days and beyond). Post-MI remodeling is a complex time-dependent process involving structural, biochemical, neurohormonal and electrophysiologic alterations. The acute loss of myocardium results in strong increase in loading conditions that induces a unique pattern of remodeling that is associated with time-dependent dilatation, distortion of ventricular shape, and hypertrophy of the non-infarcted myocardium tissue. Following a variable period of compensation, deterioration of contractile function may develop resulting in congestive heart failure.

Heart failure is a syndrome in which patients typically present with shortness of breath at rest or during effort, and/or fatigue; signs of fluid retention such as pulmonary congestion or ankle swelling; and objective evidence of an abnormality of the structure or function of the heart at rest. Coronary heart disease is by far the most common cause, being the initiating cause in 60% of patients with heart failure (Weir and McMurray 2006). In parallel to the improvement of standard of care during the acute phase, and given the ageing population, the incidence of Heart failure as a chronic disease after MI is increasing (Velagaleti et al. 2008). The prevalence of Heart failure in 70- to 80-year-old people is between 10 and 20%.

The echocardiography is the most useful method for the diagnosis of systolic and diastolic hearth failures. Recently, B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) measurements were introduced as tools for diagnosis and management of heart failure. Heart failure is accompanied by an increase in various other neurohormonal markers (norepinephrine, renin, aldosterone, endothelin, arginine vasopressin) (Dickstein et al. 2008).

Firalis evaluate new candidate prognostic biomarkers in blood and urine samples from MI patients. Several exploratory, prospective longitudinal studies are being conducted by Firalis and its clinical collaborators in MI patients to evaluate the prognostic value of novel biomarkers. Throughout these studies, subjects are treated according to standards of care for MI patients undergoing primary PCI. Each patient is followed for 6 months. Blood samples are collected before, during and after PCI in controlled conditions for the measurement of biomarker concentrations. The candidate biomarkers are evaluated for their predictive performance with regard to short, mid, and long-term outcomes.

Candidate novel clinical cardiovascular biomarkers are selected from the protected Propriatery data. Additional biomarker can be evaluated at the time of sample testing or later in the stored samples according to the most recent literature.