title: B-type natriuretic peptide and high sensitive C-reactive protein predict 2-year all cause mortality in chest pain patients: a prospective observational study from Salta, Argentina.
abstract: BACKGROUND
  Several mechanisms are involved in the pathophysiology of the Acute Coronary Syndrome (ACS). We have addressed whether B-type natriuretic peptide (BNP) and high-sensitive C-reactive protein (hsCRP) in admission samples may improve risk stratification in chest pain patients with suspected ACS.
  
  
  METHODS
  We included 982 patients consecutively admitted with chest pain and suspected ACS at nine hospitals in Salta, Northern Argentina. Total and cardiac mortality were recorded during a 2-year follow up period. Patients were divided into quartiles according to BNP and hsCRP levels, respectively, and inter quartile differences in mortality were statistically evaluated applying univariate and multivariate analyses.
  
  
  RESULTS
  119 patients died, and the BNP and hsCRP levels were significantly higher among these patients than in survivors. In a multivariable Cox regression model for total death and cardiac death in all patients, the hazard ratio (HR) in the highest quartile (Q4) as compared to the lowest quartile (Q1) of BNP was 2.32 (95% confidence interval (CI), 1.24-4.35), p = 0.009 and 3.34 (95% CI, 1.26-8.85), p = 0.015, respectively. In the TnT positive patients (TnT > 0.01 ng/mL), the HR for total death and cardiac death in Q4 as compared to Q1 was 2.12 (95% CI, 1.07-4.18), p = 0.031 and 3.42 (95% CI, 1.13-10.32), p = 0.029, respectively.The HR for total death for hsCRP in Q4 as compared to Q1 was 1.97 (95% CI, 1.17-3.32), p = 0.011, but this biomarker did not predict cardiac death (p = 0.21). No prognostic impact of these two biomarkers was found in the TnT negative patients.
  
  
  CONCLUSIONS
  BNP and hsCRP may act as clinically useful biomarkers when obtained at admission in a population with suspected ACS.
authors.affiliation: Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Ricardo
authors.initials: R
authors.lastname: León de la Fuente
authors.forename: Patrycja A
authors.initials: PA
authors.lastname: Naesgaard
authors.forename: Stein Tore
authors.initials: ST
authors.lastname: Nilsen
authors.forename: Leik
authors.initials: L
authors.lastname: Woie
authors.forename: Torbjoern
authors.initials: T
authors.lastname: Aarsland
authors.forename: Patricio
authors.initials: P
authors.lastname: Gallo
authors.forename: Heidi
authors.initials: H
authors.lastname: Grundt
authors.forename: Harry
authors.initials: H
authors.lastname: Staines
authors.forename: Dennis W T
authors.initials: DW
authors.lastname: Nilsen
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D000368:Aged; D001118:Argentina; D002097:C-Reactive Protein / Q000378:metabolism*; D002637:Chest Pain; D004632:Emergency Medical Services; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D020379:Risk Adjustment; D016019:Survival Analysis; D014336:Troponin / Q000097:blood*
chemical_list: D014336:Troponin; D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein