Comparison of N-terminal pro-B-natriuretic peptide, C-reactive protein, and creatinine clearance for prognosis in patients with known coronary heart disease

Arch Intern Med. 2006 Dec 11-25;166(22):2455-60. doi: 10.1001/archinte.166.22.2455.

Abstract

Background: The purpose of this study was to investigate the prognostic role of N-terminal pro-B-natriuretic peptide (NT-proBNP) serum level compared with C-reactive protein (CRP) level and creatinine clearance (CrCl) for the subsequent risk of cardiovascular events in a large cohort of patients with stable coronary heart disease (CHD).

Methods: Serum concentrations of NT-proBNP and CRP and CrCl were measured at baseline in a cohort of 1051 patients aged 30 to 70 years with CHD. The Cox proportional hazards model was used to determine the prognostic value of NT-proBNP, CRP, and CrCl on a combined cardiovascular disease (CVD) end point (fatal and nonfatal myocardial infarction and stroke).

Results: During follow-up (mean of 48.7 months), 95 patients (9.0%) experienced a secondary CVD event. Patients in the top quartile of the NT-proBNP distribution at baseline had a hazard ratio (HR) of 3.34 (95% confidence interval [CI], 1.74-6.45) for subsequent secondary CVD events compared with those in the bottom quartile (P for trend <.001) after controlling for age, sex, smoking status, history of diabetes mellitus, initial management of CHD, rehabilitation clinic, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and treatment with lipid-lowering drugs. For CRP, the corresponding HR was 1.76 (95% CI, 0.96-3.24) (P value for trend, .06). Patients with CrCl levels lower than 60 mL/min had an HR of 2.39 (95% CI, 1.06-5.40) compared with patients with a CrCl of 90 mL/min or higher (P for trend, .002). If all 3 markers were included simultaneously in 1 model, NT-proBNP still showed predictive ability for recurrent CVD events.

Conclusion: N-terminal proBNP may be a clinically useful marker weeks after an acute coronary event and may provide complementary prognostic information to established risk determinants.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Area Under Curve
  • C-Reactive Protein / analysis*
  • Confounding Factors, Epidemiologic
  • Coronary Disease / blood
  • Coronary Disease / diagnosis*
  • Creatinine / blood*
  • Electrocardiography
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Natriuretic Peptide, Brain / blood*
  • Peptide Fragments / blood*
  • Prognosis
  • Prospective Studies
  • ROC Curve
  • Risk Assessment

Substances

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