title: Joint effects of N-terminal pro-B-type-natriuretic peptide and C-reactive protein vs angiographic severity in predicting major adverse cardiovascular events and clinical restenosis after coronary angioplasty in patients with stable coronary artery disease.
abstract: BACKGROUND
  This study was designed to evaluate the joint effects of plasma C-reactive protein (CRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) vs coronary angiographic severity on cardiovascular risk stratification.
  
  
  RESULTS
  A total of 345 patients with stable coronary artery disease (CAD) were recruited after successful percutaneous coronary intervention (PCI). Endpoints were major adverse cardiovascular events (MACE) and cumulative clinical restenosis rate after 18-36-month follow-up. Plasma NT-proBNP and CRP levels were among the strongest predictors of MACE. Adjusted hazard ratios of MACE according to combined biomarkers were 2.4 (p=0.05) for elevated CRP only, 5.22 (p<0.001) for elevated NT-proBNP only, and 7.04 (p<0.001) for elevation of both. The differential capacity using both plasma CRP and NT-proBNP in a receiver-operating-characteristics curve analysis (area under curve, AUC: 0.82) was significantly higher than using either biomarker alone or conventional risk factors (AUC: 0.67). Significant predictors of clinical restenosis were plasma NT-proBNP and the Gensini score. The combination of NT-proBNP and the Gensini score was the strongest predictor (AUC: 0.77) for clinical restenosis.
  
  
  CONCLUSIONS
  Plasma NT-proBNP, CRP, and the Gensini score are complementary in risk stratification. Combined use of these biomarkers has provided substantial extra information to conventional risk factors in stable CAD patients.
authors.affiliation: Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Dao-Fu
authors.initials: DF
authors.lastname: Dai
authors.forename: Juey-Jen
authors.initials: JJ
authors.lastname: Hwang
authors.forename: Jiunn-Lee
authors.initials: JL
authors.lastname: Lin
authors.forename: Jou-Wei
authors.initials: JW
authors.lastname: Lin
authors.forename: Chih-Neng
authors.initials: CN
authors.lastname: Hsu
authors.forename: Chih-Min
authors.initials: CM
authors.lastname: Lin
authors.forename: Fu-Tien
authors.initials: FT
authors.lastname: Chiang
authors.forename: Ling-Ping
authors.initials: LP
authors.lastname: Lai
authors.forename: Kwan-Lih
authors.initials: KL
authors.lastname: Hsu
authors.forename: Chuen-Den
authors.initials: CD
authors.lastname: Tseng
authors.forename: Yung-Zu
authors.initials: YZ
authors.lastname: Tseng
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000378:metabolism; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000378:metabolism / Q000628:therapy*; D023903:Coronary Restenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000378:metabolism; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein