Concentrations of C-reactive protein and B-type natriuretic peptide 30 days after acute coronary syndromes independently predict hospitalization for heart failure and cardiovascular death.
BACKGROUND
Heart failure (HF) is an important cause of morbidity in patients with acute coronary syndromes (ACS). C-reactive protein (CRP) has been implicated in experimental models as exacerbating myocardial injury, but data regarding the clinical relationship of high-sensitivity CRP (hsCRP) and B-type natriuretic peptide (BNP) concentrations with the risk of HF after ACS are few.


METHODS
PROVE IT-TIMI 22 randomized 4162 patients who had been stabilized after ACS to either intensive or moderate statin therapy. hsCRP and BNP were measured 30 days after randomization. Hospitalizations for HF and cardiovascular death occurring after day 30 were assessed for a mean follow-up of 24 months.


RESULTS
Patients who developed HF had higher concentrations of hsCRP (3.7 mg/L vs 1.9 mg/L, P < 0.001) and BNP (59 ng/L vs 22 ng/L, P < 0.0001). HF increased in a stepwise manner with hsCRP quartile [adjusted hazard ratio (HR(adj)) for Q4 vs Q1, 2.5; P = 0.01] and BNP quartile (HR(adj) for Q4 vs Q1, 5.8; P < 0.001), with similar results obtained for HF and cardiovascular death. In a multivariable analysis, higher concentrations of hsCRP and BNP were both independently associated with HF [HR(adj), 1.9 for hsCRP >2.0 mg/L (P = 0.01) and 4.2 for BNP >80 ng/L (P < 0.001)]. Patients with increases in both markers were at the greatest risk of HF, compared with patients without an increased marker concentration (HR(adj), 8.3; P = 0.01). The benefit of intensive statin therapy in reducing HF was consistent among all patients, regardless of hsCRP or BNP concentration.


CONCLUSIONS
Both hsCRP and BNP measured 30 days after ACS are independently associated with the risk of HF and cardiovascular death, with the greatest risk occurring when both markers are increased.
Scirica
Benjamin M
BM
TIMI Study Group, Cardiovascular Division, Department of Medicine, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. bscirica@partners.org
Cannon
Christopher P
CP
Sabatine
Marc S
MS
Jarolim
Petr
P
Sloane
Sarah
S
Rifai
Nader
N
Braunwald
Eugene
E
Morrow
David A
DA
D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D015415:Biomarkers / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis*; D004311:Double-Blind Method; D019317:Evidence-Based Medicine; D006333:Heart Failure / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000032:analysis*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012306:Risk
D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein