title: Derived fibrinogen compared with C-reactive protein and brain natriuretic peptide for predicting events after myocardial infarction and coronary stenting.
abstract: BACKGROUND
  After myocardial infarction (MI), biomarkers can be helpful to identify patients who might benefit from more intensive therapies. The prothrombin time-derived fibrinogen (PTDF) assay is widely available and relatively inexpensive. We determined whether PTDF predicts events in patients with MI and compared this assay with brain natriuretic peptide (BNP) and C-reactive protein (CRP).
  
  
  METHODS
  We retrospectively analyzed data from 915 patients admitted with MI. Follow-up was collected at 1 year for major adverse cardiac events (MACE) defined as death from any cause, nonfatal MI or death, target vessel revascularization, or coronary artery bypass grafting.
  
  
  RESULTS
  Patients in the fourth quartile of PTDF were older and had more risk factors but fewer ST-elevation MI and lower peak troponin values. The fourth quartiles of PTDF, CRP, and BNP were associated with increased MACE compared with the first quartiles with hazard ratios of 2.08 (1.30-3.33), 1.94 (1.22-3.07), and 2.56 (1.57-4.18), respectively, findings that remained significant after adjustment. When outcomes by strata of PTDF were examined, CRP failed to add additional prognostic value. Higher BNP levels predicted MACE in the upper but not lower stratum of PTDF.
  
  
  CONCLUSIONS
  In patients with MI, PTDF is a predictor of MACE at 1 year, with equivalent value compared to BNP and CRP. With low PTDF levels, neither BNP nor CRP adds prognostic value. At elevated PTDF values, higher BNP, but not CRP, identifies a higher-risk population. Therefore, PTDF can be substituted for CRP, with BNP being useful in the presence of elevated PTDF.
authors.affiliation: Cardiology Section, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1045, USA.
authors.forename: Terry R
authors.initials: TR
authors.lastname: Ketch
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Turner
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Sacrinty
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Lingle
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Applegate
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kutcher
authors.forename: David C
authors.initials: DC
authors.lastname: Sane
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002097:C-Reactive Protein / Q000032:analysis*; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D005260:Female; D005340:Fibrinogen / Q000032:analysis*; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality / Q000628:therapy; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D016016:Proportional Hazards Models; D011517:Prothrombin Time; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D015607:Stents
chemical_list: D020097:Natriuretic Peptide, Brain; D005340:Fibrinogen; D002097:C-Reactive Protein