title: Serial measurements of N-terminal pro-brain natriuretic peptide in patients with coronary heart disease.
abstract: OBJECTIVE
  To assess the prognostic value of 12-months N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP) levels on adverse cardiovascular events in patients with stable coronary heart disease.
  
  
  METHODS
  NT-proBNP concentrations were measured at baseline and at 12-months follow-up in participants of cardiac rehabilitation (median follow-up 8.96 years). Cox-proportional hazards models evaluated the prognostic value of log-transformed NT-proBNP levels, and of 12-months NT-proBNP relative changes on adverse cardiovascular events adjusting for established risk factors measured at baseline.
  
  
  RESULTS
  Among 798 participants (84.7% men, mean age 59 years) there were 114 adverse cardiovascular events. 12-months NT-proBNP levels were higher than baseline levels in 60 patients (7.5%) and numerically more strongly associated with the outcome in multivariable analysis (HR 1.65 [95% CI 1.33-2.05] vs. HR 1.41 [95% CI 1.12-1.78], with a net reclassification improvement (NRI) of 0.098 [95% CI 0.002-0.194] compared to NRI of 0.047 [95% CI -0.0004-0.133] for baseline NT-proBNP levels. A 12-month 10% increment of NT-proBNP was associated with a HR of 1.35 [95% CI 1.12-1.63] for the onset of an adverse cardiovascular event. Subjects with a 12-month increment of NT-proBNP had a HR of 2.56 [95% CI 1.10-5.95] compared to those with the highest 12-months reduction.
  
  
  CONCLUSIONS
  Twelve-months NT-proBNP levels after an acute cardiovascular event are strongly associated with a subsequent event and may provide numerically better reclassification of patients at risk for an adverse cardiovascular event compared to NT-proBNP baseline levels after adjustment for established risk factors.
authors: University of Ulm Medical Center, Department of Internal Medicine II-Cardiology, Ulm, Germany; Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States of America; Ulm University, Institute of Epidemiology and Medical Biometry, Ulm, Germany.
authors: Dhayana
authors: D
authors: Dallmeier
authors: Duke Clinical Research Institute, Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, United States of America.
authors: Michael J
authors: MJ
authors: Pencina
authors: Novartis Institute of Biomedical Research, Basel, Switzerland.
authors: Iris
authors: I
authors: Rajman
authors: University of Ulm Medical Center, Department of Internal Medicine II-Cardiology, Ulm, Germany.
authors: Wolfgang
authors: W
authors: Koenig
authors: Ulm University, Institute of Epidemiology and Medical Biometry, Ulm, Germany.
authors: Dietrich
authors: D
authors: Rothenbacher
authors: German Cancer Research Center, Division of Clinical Epidemiology & Aging Research, Heidelberg, Germany.
authors: Hermann
authors: H
authors: Brenner
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis*; D003327:Coronary Disease / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
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