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

Dennis W T Nilsen, Øistein Rønneberg Mjelva, Ricardo A Leon de la Fuente, Patrycja Naesgaard, Volker Pönitz, Trygve Brügger-Andersen, Heidi Grundt, Harry Staines, Stein Tore Nilsen, Dennis W T Nilsen, Øistein Rønneberg Mjelva, Ricardo A Leon de la Fuente, Patrycja Naesgaard, Volker Pönitz, Trygve Brügger-Andersen, Heidi Grundt, Harry Staines, Stein Tore Nilsen

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).

Conclusion: 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.

Keywords: acute coronary syndrome; biomarkers; brain natriuretic peptide; cardiac mortality; chest-pain; high sensitivity C-reactive protein; total mortality; troponin-T.

Figures

Figure 1
Figure 1
Kaplan–Meier plot of time to all-cause mortality within 2 years by BNP quartiles.
Figure 2
Figure 2
Kaplan–Meier plot of time to all-cause mortality within 2 years by hsCRP quartiles.
Figure 3
Figure 3
ROC for all-cause mortality at 2 years: BNP, CRP, and TnT.
Figure 4
Figure 4
Kaplan–Meier plot of time to cardiac death within 2 years by BNP quartiles.
Figure 5
Figure 5
Kaplan–Meier plot of time to cardiac death within 2 years by hsCRP quartiles.
Figure 6
Figure 6
ROC for cardiac death at 2 years: BNP, CRP, and TnT.

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