title: Risk stratification in stable coronary artery disease:  superiority of N-terminal pro B-type natriuretic peptide over high-sensitivity C-reactive protein, gamma-glutamyl transferase, and traditional risk factors.
abstract: OBJECTIVE
  The aim of the study was to compare N-terminal pro B-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein, and gamma-glutamyl transferase (γ-GT) with traditional risk markers for estimating prognosis in patients with stable coronary artery disease (CAD).
  
  
  METHODS
  Evaluation of mortality and a combined clinical endpoint (mortality, need for coronary revascularization, myocardial infarction, hospitalization for cardiac causes, or stroke) during an average 3.2-year follow-up in 394 consecutive patients (73% male patients, age: 67±9 years) with angiographically proven stable CAD.
  
  
  RESULTS
  Univariate Kaplan-Meier survival rate analysis showed that traditional risk markers, apart from impaired renal function, three-vessel CAD, and a reduced left ventricular function at the time of coronary angiography, were not of prognostic relevance for prediction of outcome. NT-proBNP, high-sensitivity C-reactive protein, and gamma-glutamyl transferase were significant predictors of mortality; however, only NT-proBNP was a significant predictor of the combined endpoint. In age-adjusted and sex-adjusted multivariate Cox regression analysis, NT-proBNP was the strongest independent predictor of the combined endpoint (odds ratio 2.92, 95% confidence interval: 1.72-4.94, first vs. third tertile). All three laboratory parameters remained independent risk markers for mortality in multivariate analysis. NT-proBNP, however, revealed the highest odds ratio (5.23, 95% confidence interval: 1.17-23.23, first vs. third tertile). Concentrations greater than 356 ng/l predicted mortality with a sensitivity of 70%, a specificity of 71%, a positive likelihood ratio of 2.4, and a negative likelihood ratio of 0.42.
  
  
  CONCLUSIONS
  In comparison with other tested novel biomarkers and traditional risk markers, NT-proBNP was the most predictive prognostic marker in multivariate analysis in patients with stable CAD.
authors.affiliation: Department of Internal Medicine III-Cardiology, Innsbruck Medical University, Austria.
authors.forename: Edmund
authors.initials: E
authors.lastname: Bode
authors.forename: Thomas
authors.initials: T
authors.lastname: Wuppinger
authors.forename: Thomas
authors.initials: T
authors.lastname: Bode
authors.forename: Hannes
authors.initials: H
authors.lastname: Alber
authors.forename: Hanno
authors.initials: H
authors.lastname: Ulmer
authors.forename: Otmar
authors.initials: O
authors.lastname: Pachinger
authors.forename: Johannes
authors.initials: J
authors.lastname: Mair
mesh_terms: D000368:Aged; D001317:Austria / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D018450:Disease Progression; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D015996:Survival Rate / Q000639:trends; D005723:gamma-Glutamyltransferase / Q000097:blood*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein; D005723:gamma-Glutamyltransferase