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


CONCLUSIONS
Combined use of NT-proBNP and CRP improves long-term risk prediction of mortality in patients with stable coronary heart disease.
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany. ndrepepa@dhm.mhn.de
Gjin
G
Ndrepepa
Adnan
A
Kastrati
Siegmund
S
Braun
Julinda
J
Mehilli
Kathrin
K
Niemöller
Nicolas
N
von Beckerath
Olga
O
von Beckerath
Wolfgang
W
Vogt
Albert
A
Schömig
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000097:blood* / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D023903:Coronary Restenosis / Q000097:blood / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016017:Odds Ratio; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein