title: Borderline Values of Troponin-T and High Sensitivity C-Reactive Protein Did Not Predict 2-Year Mortality in TnT Positive Chest-Pain Patients, Whereas Brain Natriuretic Peptide Did.
abstract: BACKGROUND
  Troponin-T (TnT), high-sensitive C-reactive protein (hsCRP), and Brain Natriuretic Peptide (BNP) have been shown to be independent prognostic indicators of total and cardiac death during short- and long-term follow-up.
  
  
  METHODS
  We investigated prospectively the prognostic value of admission samples of TnT, hsCRP, and BNP in 871 chest-pain patients from South-Western Norway and 982 patients from Northern Argentina, based on a similar protocol and database setup. Follow-up was 2 years for the pooled population. The prognostic value of the selected biomarkers was investigated in quartiles of 239 patients with TnT values greater than 0.01 and up to and including 0.1 ng/mL, with continuous TnT as a potential confounder.
  
  
  RESULTS
  After 24 months, 69 patients had died, of whom 38 died from cardiac causes. In the selected range of TnT, this biomarker was not significantly different between patients who died and survived (mean 0.0452 and 0.0457, p = 0.887). The BNP levels were significantly higher among patients dying than in long-term survivors [340 (142-656) versus 157 (58-367) pg/mL (median, 25 and 75% percentiles), p < 0.001]. In a multivariable Cox regression model for death within 2 years, the hazard ratio (HR) for BNP in the highest quartile (Q4) as compared to the lowest (Q1) was significantly related to total mortality [HR 2.84 (95% confidence interval (CI), 1.13-7.17)], p = 0.027, in addition to age (p ≤ 0.001) and hypercholesterolemia (p = 0.043). For cardiac death, the HR for BNP was 5.18 (95% CI, 1.06-25.3), p = 0.042. Several other variables (age, congestive heart failure, ST elevation myocardial infarction, and study country) were also significantly related to cardiac death. In a multivariable Cox regression model, hsCRP rendered no significant prognostic information for all-cause mortality (p = 0.089) or for cardiac mortality (p = 0.524).
  
  
  CONCLUSIONS
  In patients with borderline TnT values (greater than 0.01 and up to and including 0.1 ng/mL), this biomarker as well as hsCRP did not render prognostic information, whereas BNP was found to be a strong prognostic indicator of 2-year total and cardiac mortality.
authors.affiliation: Department of Cardiology, Stavanger University Hospital , Stavanger , Norway ; Department of Clinical Science, University of Bergen , Bergen , Norway.
authors.forename: Dennis W T
authors.initials: DW
authors.lastname: Nilsen
authors.affiliation: Department of Clinical Science, University of Bergen , Bergen , Norway ; Department of Medicine, Stavanger University Hospital , Stavanger , Norway.
authors.forename: Øistein Rønneberg
authors.initials: ØR
authors.lastname: Mjelva
authors.affiliation: Cardiology Research Institute, Catholic University of Salta , Salta , Argentina.
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Leon de la Fuente
authors.affiliation: Department of Cardiology, Stavanger University Hospital , Stavanger , Norway ; Department of Clinical Science, University of Bergen , Bergen , Norway.
authors.forename: Patrycja
authors.initials: P
authors.lastname: Naesgaard
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 Clinical Science, University of Bergen , Bergen , Norway ; Department of Medicine, Stavanger University Hospital , Stavanger , 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 Research, Stavanger University Hospital , Stavanger , Norway ; Department of Clinical Medicine, University of Bergen , Bergen , Norway.
authors.forename: Stein Tore
authors.initials: ST
authors.lastname: Nilsen
keywords: acute coronary syndrome; biomarkers; brain natriuretic peptide; cardiac mortality; chest-pain; high sensitivity C-reactive protein; total mortality; troponin-T