This forward-looking clinical investigation explored the prognostic utility of four distinct 
biomarkers—high-sensitivity cardiac troponin T (hs-cTnT), N-terminal pro b-type 
natriuretic peptide (NT-proBNP), Copeptin, and Mid-regional pro-Adrenomedullin (MR
proADM)—in forecasting significant cardiovascular complications among 120 individuals 
presenting with symptoms suggestive of acute coronary syndrome (ACS) in an emergency 
care setting. Across a 12-month observation window, occurrences of major adverse 
cardiovascular events (MACE)—encompassing myocardial infarction, stroke, and 
cardiovascular mortality—were systematically tracked and correlated with both initial and 
serial biomarker measurements. 
Multivariate analysis using Cox proportional hazards modeling, adjusted for demographic 
and behavioral risk factors such as age, sex, and smoking, revealed a robust association 
between elevated biomarker levels and MACE incidence. Diagnostic accuracy for each 
marker—individually and collectively—was assessed through ROC curve analysis, 
demonstrating favorable area under the curve (AUC) values indicative of strong predictive 
performance. Survival outcomes stratified by median biomarker thresholds were estimated 
using Kaplan-Meier methodology, showing pronounced differences in MACE-free survival 
between high- and low-risk groups. 
The findings affirm the clinical value of hs-cTnT, NT-proBNP, Copeptin, and MR-proADM in 
early cardiovascular risk stratification. Moreover, the integrative use of these markers was 
shown to outperform any single biomarker alone, emphasizing their combined role in 
refining diagnostic precision and guiding therapeutic decisions. These results support 
incorporating such biomarker panels into routine evaluation protocols for patients 
undergoing assessment for suspected ACS.