title: Long-term prognostic utility of pentraxin 3 and D-dimer as compared to high-sensitivity C-reactive protein and B-type natriuretic peptide in suspected acute coronary syndrome.
abstract: Vascular inflammation plays a key role in the development of atherosclerosis and acute coronary syndrome (ACS), and pentraxin 3 (PTX3) is one of several novel, promising markers of inflammation. In addition, D-dimer might serve as a marker of thrombogenesis and a hypercoagulable state following plaque rupture. The present study assesses the prognostic utility of these two biomarkers as compared to high-sensitivity C-reactive protein (hsCRP) and B-type natriuretic peptide (BNP), in addition to conventional clinical risk factors for coronary heart disease in patients with suspected ACS.
  
  
  
  Chest pain patients with suspected ACS (n = 871) were consecutively included in a prospective, observational study with a follow-up time of 84 months.
  
  
  
  At 7-year follow-up, 332 patients had died and 203 had suffered an adverse troponin T-positive, non-fatal cardiac event. In the multivariate analysis, levels of PTX3 above 5.88 ng/mL (median) and D-dimer above 436 µg/L (lower limit upper quartile) independently predicted mortality (HR 1.60 [95% CI 1.10-2.33]; p = 0.014 and HR 1.83 [95% CI 1.20-2.78]; p = 0.005, respectively). Also, BNP levels above 310.75 pg/mL (lower limit upper quartile) (HR 2.16 [95% CI 1.37-3.42]; p = 0.001), but not hsCRP, independently predicted mortality. Only hsCRP and BNP also predicted future myocardial infarction (HR 1.59 [95% CI 1.05-2.40]; p = 0.029 and HR 1.91 [95% CI 1.10-3.31]; p = 0.021, respectively).
  
  
  
  High levels of PTX3, D-dimer and BNP were found to be independent, long-term predictors of all-cause mortality in chest pain patients with a suspected ACS. hsCRP and BNP also predicted future myocardial infarction.
authors.affiliation: Department of Medicine, Stavanger University Hospital, Stavanger, Norway Department of Clinical Science, University of Bergen, Bergen, Norway oisteinm@broadpark.no.
authors.forename: Øistein R
authors.initials: ØR
authors.lastname: Mjelva
authors.affiliation: Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Volker
authors.initials: V
authors.lastname: Pönitz
authors.affiliation: Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Trygve
authors.initials: T
authors.lastname: Brügger-Andersen
authors.affiliation: Department of Medicine, Stavanger University Hospital, Stavanger, Norway Department of Clinical Science, University of Bergen, Bergen, Norway.
authors.forename: Heidi
authors.initials: H
authors.lastname: Grundt
authors.affiliation: Sigma Statistical Services, Balmullo, UK.
authors.forename: Harry
authors.initials: H
authors.lastname: Staines
authors.affiliation: Department of Clinical Science, University of Bergen, Bergen, Norway Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Dennis Wt
authors.initials: DW
authors.lastname: Nilsen
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000401:mortality; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D002423:Cause of Death / Q000639:trends; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D005500:Follow-Up Studies; D006801:Humans; D000074024:Immunoturbidimetry; D007249:Inflammation / Q000097:blood; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009664:Norway / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D000683:Serum Amyloid P-Component / Q000378:metabolism*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D000099153:Pentraxins
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein; D005338:Fibrin Fibrinogen Degradation Products; D020097:Natriuretic Peptide, Brain; D000683:Serum Amyloid P-Component; D000099153:Pentraxins; C036309:fibrin fragment D
keywords: BNP; D-dimer; Pentraxin 3; acute coronary syndrome; hsCRP; mortality; myocardial infarction; prognostic biomarkers