Gjin Ndrepepa MD, Deutsches Herzzentrum, Lazarettstrasse 36, 80636 München, Germany. Tel.: +49 89 12181535; fax: +49 89 12184053; e-mail: [email protected]

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Abstract

Eur J Clin Invest 2011; 41 (10): 1054–1062

Background High-sensitivity cardiac troponin (hs-TnT) and N-terminal probrain natriuretic peptide (NT-proBNP) are powerful predictors of mortality in patients with stable coronary artery disease. Whether their combined use may further improve mortality prediction in these patients is unknown.

Materials and methods The study included 869 patients with stable coronary artery disease who underwent percutaneous coronary intervention. Hs-TnT and NT-proBNP were measured before angiography. Using median values of hs-TnT (0·008 μg L⁻¹) and NT-proBNP (250·0 ng L⁻¹) as cut-off points, patients were divided into four groups: low hs-TnT/low NT-proBNP group (293 patients with hs-TnT and NT-proBNP < median); low hs-TnT/high NT-proBNP group (142 patients with hs-TnT < median and NT-proBNP ≥ median); high hs-TnT/low NT-proBNP group (142 patients with hs-TnT ≥ median and NT-proBNP < median) and high hs-TnT/high NT-proBNP group (292 patients with hs-TnT and NT-proBNP ≥ median). The primary end point was all-cause mortality.

Results The 4-year follow-up was complete in 90·7% of the patients. There were 76 deaths during the follow-up: seven in low hs-TnT/low NT-proBNP, 8 in low hs-TnT/high NT-proBNP, 10 in high hs-TnT/low NT-proBNP and 51 in high hs-TnT/high NT-proBNP groups (mortality estimates, 2·5%, 5·9%, 7·4% and 18·1%, respectively; odds ratio = 8·64, 95% confidence interval 3·85–19·4, P < 0·001 for high hs-TnT/high NT-proBNP vs. low hs-TnT/low NT-proBNP). Inclusion of hs-TnT and NT-proBNP in the multivariable model increased the discriminatory power of the model regarding mortality prediction compared with the model without biomarkers (absolute and relative integrated discrimination improvement 0·039 and 26·0%, P = 0·0015).

Conclusions Combined use of hs-TnT and NT-proBNP improves long-term risk prediction of mortality in patients with stable coronary heart disease.

References

1 Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G et al. Heart disease and stroke statistics-2010 update: a report from the American Heart Association. Circulation 2010; 121: e46–215.
PubMed Web of Science® Google Scholar
2 Hunink MG, Goldman L, Tosteson AN, Mittleman MA, Goldman PA, Williams LW et al. The recent decline in mortality from coronary heart disease, 1980–1990. The effect of secular trends in risk factors and treatment. JAMA 1997; 277: 535–42.
CAS PubMed Web of Science® Google Scholar
3 Morris RW, Whincup PH, Lampe FC, Walker M, Wannamethee SG, Shaper AG. Geographic variation in incidence of coronary heart disease in Britain: the contribution of established risk factors. Heart 2001; 86: 277–83.
10.1136/heart.86.3.277
CAS PubMed Web of Science® Google Scholar
4 Wang TJ, Gona P, Larson MG, Tofler GH, Levy D, Newton-Cheh C et al. Multiple biomarkers for the prediction of first major cardiovascular events and death. N Engl J Med 2006; 355: 2631–9.
10.1056/NEJMoa055373
CAS PubMed Web of Science® Google Scholar
5 Melander O, Newton-Cheh C, Almgren P, Hedblad B, Berglund G, Engström G et al. Novel and conventional biomarkers for prediction of incident cardiovascular events in the community. JAMA 2009; 302: 49–57.
10.1001/jama.2009.943
CAS PubMed Web of Science® Google Scholar
6 Blankenberg S, Zeller T, Saarela O, Havulinna AS, Kee F, Tunstall-Pedoe H et al. Contribution of 30 biomarkers to 10-year cardiovascular risk estimation in 2 population cohorts: the MONICA, risk, genetics, archiving, and monograph (MORGAM) biomarker project. Circulation. 2010; 121: 2388–97.
10.1161/CIRCULATIONAHA.109.901413
PubMed Web of Science® Google Scholar
7 Schnabel RB, Schulz A, Messow CM, Lubos E, Wild PS, Zeller T et al. Multiple marker approach to risk stratification in patients with stable coronary artery disease. Eur Heart J 2010; 31: 3024–31.
10.1093/eurheartj/ehq322
CAS PubMed Web of Science® Google Scholar
8 Kragelund C, Grønning B, Køber L, Hildebrandt P, Steffensen R. N-terminal pro-B-type natriuretic peptide and long-term mortality in stable coronary heart disease. N Engl J Med 2005; 352: 666–75.
10.1056/NEJMoa042330
CAS PubMed Web of Science® Google Scholar
9 Ndrepepa G, Braun S, Niemöller K, Mehilli J, von Beckerath N, von Beckerath O et al. Prognostic value of N-terminal pro-brain natriuretic peptide in patients with chronic stable angina. Circulation 2005; 112: 2102–7.
10.1161/CIRCULATIONAHA.105.550715
CAS PubMed Web of Science® Google Scholar
10 Omland T, de Lemos JA, Sabatine MS, Christophi CA, Rice MM, Jablonski KA et al. A sensitive cardiac troponin T assay in stable coronary artery disease. N Engl J Med 2009; 361: 2538–47.
10.1056/NEJMoa0805299
CAS PubMed Web of Science® Google Scholar
11 Ndrepepa G, Braun S, Mehilli J, Birkmeier KA, Byrne RA, Ott I et al. Prognostic Value of Sensitive Troponin T in Patients with Stable and Unstable Angina and Undetectable Conventional Troponin. Am Heart J 2011; 161: 68–75.
10.1016/j.ahj.2010.09.018
CAS PubMed Web of Science® Google Scholar
12 Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976; 16: 31–41.
10.1159/000180580
CAS PubMed Web of Science® Google Scholar
13 Simera I, Moher D, Hoey J, Schulz KF, Altman DG. A catalogue of reporting guidelines for health research. Eur J Clin Invest 2010; 40: 35–53.
10.1111/j.1365-2362.2009.02234.x
CAS PubMed Web of Science® Google Scholar
14 Pencina MJ, D’Agostino RB Sr, D’Agostino RB Jr, Vasan RS. Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond. Stat Med 2008; 27: 157–72; discussion 207-12.
10.1002/sim.2929
PubMed Web of Science® Google Scholar
15 Venge P, Johnston N, Lindahl B, James S. Normal plasma levels of cardiac troponin I measured by the high-sensitivity cardiac troponin I access prototype assay and the impact on the diagnosis of myocardial ischemia. J Am Coll Cardiol 2009; 54: 1165–72.
10.1016/j.jacc.2009.05.051
CAS PubMed Web of Science® Google Scholar
16 James SK, Lindahl B, Siegbahn A, Stridsberg M, Venge P, Armstrong P et al. N-terminal pro-brain natriuretic peptide and other risk markers for the separate prediction of mortality and subsequent myocardial infarction in patients with unstable coronary artery disease: a Global Utilization of Strategies To Open occluded arteries (GUSTO) – IV substudy. Circulation 2003; 108: 275–81.
10.1161/01.CIR.0000079170.10579.DC
CAS PubMed Web of Science® Google Scholar
17 Mark DB, Felker GM. B-type natriuretic peptide - a biomarker for all seasons? N Engl J Med 2004; 350: 718–20.
10.1056/NEJMe038233
CAS PubMed Web of Science® Google Scholar

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Volume41, Issue10

October 2011

Pages 1054-1062

Sensitive troponin and N-terminal probrain natriuretic peptide in stable angina

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Sensitive troponin and N-terminal probrain natriuretic peptide in stable angina

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