N-terminal probrain natriuretic peptide and C-reactive protein in stable coronary heart disease

Am J Med. 2006 Apr;119(4):355.e1-8. doi: 10.1016/j.amjmed.2005.10.060.

Abstract

Purpose: C-reactive protein (CRP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) provide prognostic information in patients with stable coronary heart disease. The aim of the study was to investigate whether combined use of NT-proBNP and CRP improves risk stratification in these patients.

Methods: This cohort study included 989 patients with stable coronary heart disease who underwent coronary stenting. CRP and NT-proBNP were measured before angiography. The primary end point of the study was all-cause mortality. Using median values of NT-proBNP (279.9 ng/L) and CRP (1.2 mg/L), patients were divided into 4 groups: low NT-proBNP-low CRP group (305 patients with NT-proBNP<median and CRP<median); low NT-proBNP-high CRP group (190 patients with NT-proBNP<median and CRP> or =median; high NT-proBNP-low CRP group (237 patients with NT-proBNP> or =median and CRP<median); and high NT-proBNP-high CRP group (257 patients with NT-proBNP> or =median and CRP> or =median).

Results: During a median follow-up of 3.6 years (interquartile range 3.3 to 4.5 years), there were 85 deaths: 6 deaths in the low NT-proBNP-low CRP group, 11 deaths in the low NT-proBNP-high CRP group, 20 deaths in the high NT-proBNP-low CRP group, and 48 deaths in the high NT-proBNP-high CRP group with Kaplan-Meier mortality estimates of 2.7%, 8.9%, 12.1% and 35.6%, respectively (P <.001). Cox proportional hazards model showed that combination NT-proBNP-CRP was the strongest independent correlate of mortality (hazard ratio [HR] 4.3, 95% confidence interval [CI], 2.0-9.3; P <.001 for high NT-proBNP-high CRP vs low NT-proBNP-low CRP).

Conclusion: Combined use of NT-proBNP and CRP improves long-term risk prediction of mortality in patients with stable coronary heart disease.

MeSH terms

  • Aged
  • Biomarkers / blood
  • C-Reactive Protein / metabolism*
  • Coronary Angiography
  • Coronary Disease / blood*
  • Coronary Disease / diagnostic imaging
  • Coronary Disease / mortality*
  • Coronary Disease / pathology
  • Coronary Disease / therapy
  • Coronary Restenosis / blood
  • Coronary Restenosis / mortality
  • Female
  • Follow-Up Studies
  • Germany / epidemiology
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Natriuretic Peptide, Brain / blood*
  • Odds Ratio
  • Peptide Fragments / blood*
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Stents
  • Treatment Outcome

Substances

  • Biomarkers
  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain
  • C-Reactive Protein