B-type natriuretic peptide is a long-term predictor of all-cause mortality, whereas high-sensitive C-reactive protein predicts recurrent short-term troponin T positive cardiac events in chest pain patients: a prognostic study

Trygve Brügger-Andersen, Volker Pönitz, Harry Staines, David Pritchard, Heidi Grundt, Dennis W T Nilsen, Trygve Brügger-Andersen, Volker Pönitz, Harry Staines, David Pritchard, Heidi Grundt, Dennis W T Nilsen

Abstract

Background: Few studies have addressed whether the combined use of B-type natriuretic peptide (BNP) and high-sensitive C-reactive protein (hsCRP) improves risk stratification for mortality and cardiovascular events in a population with chest pain and suspected acute coronary syndromes (ACS). Therefore, we wanted to assess the incremental prognostic value of these biomarkers with respect to long-term all-cause mortality and recurrent troponin T (TnT) positive cardiac events in 871 patients admitted to the emergency department.

Methods: Blood samples were obtained immediately following admission.

Results: After a follow-up period of 24 months, 129 patients had died. The BNP levels were significantly higher among patients dying than in long-term survivors (401 (145-736) versus 75 (29-235) pq/mL [median, 25 and 75% percentiles], p = 0.000). In a multivariable Cox regression model for death within 2 years, the hazard ratio (HR) for BNP in the highest quartile (Q4) was 5.13 (95% confidence interval (CI), 1.97-13.38) compared to the lowest quartile (Q1) and was associated with all-cause mortality above and beyond age, congestive heart failure and the index diagnosis ST-segment elevation myocardial infarction. HsCRP rendered no prognostic information for all-cause mortality. However, within 30 days, the adjusted HR for patients with recurrent TnT cardiac positive events hsCRP in Q4 was 14.79 (95% CI, 1.89-115.63) compared with Q1 and was associated with recurrent ischemic events above and beyond age, hypercholesterolemia and TnT values at admission.

Conclusion: BNP may act as a clinically useful biomarker when obtained at admission in an unselected patient population following hospitalization with chest pain and potential ACS, and may provide complementary prognostic information to established risk determinants at long-term follow-up. Our data do not support the hypothesis that the additional assessment of hsCRP will lead to better risk stratification for survival than BNP alone.

Trial registration: ClinicalTrials.gov NCT00521976.

Figures

Figure 1
Figure 1
Kaplan-Meier plots for the cumulative risk of the primary events (total mortality) for the BNP- and hsCRP quartiles, respectively. *Log Rank (Mantel-Cox) test of equality of survival distribution for the different levels of the BNP and hsCRP quartiles (univariate analysis).
Figure 2
Figure 2
Receiver operated characteristics curve for BNP.
Figure 3
Figure 3
Kaplan-Meier plots for the cumulative risk of cardiac death or recurrent TnT positive cardiac events for the BNP- and hsCRP quartiles, respectively. *Log Rank (Mantel-Cox) test of equality of survival distribution for the different levels of the BNP and hsCRP quartiles (univariate analysis).
Figure 4
Figure 4
Kaplan-Meier plots for the cumulative risk of recurrent TnT positive cardiac events for the BNP- and hsCRP quartiles, respectively. *Log Rank (Mantel-Cox) test of equality of survival distribution for the different levels of the BNP and hsCRP quartiles (univariate analysis).

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