European Heart Journal Advance Access originally published online on November 30, 2004
European Heart Journal 2005 26(3):241-249; doi:10.1093/eurheartj/ehi036
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European Heart Journal vol. 26 no. 3 © The European Society of Cardiology 2004; all rights reserved.
Analysis of N-terminal-pro-brain natriuretic peptide and C-reactive protein for risk stratification in stable and unstable coronary artery disease: results from the AtheroGene study
1Department of Medicine II, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
2INSERM U525, Faculté de Médecine Pitié-Salpêtrière, Paris, France
3Department of Clinical Chemistry, Johannes Gutenberg-University Mainz, Germany
4Innere Abteilung Bundeswehrzentralkrankenhaus, Koblenz, Germany
Received 17 January 2004; revised 27 August 2004; accepted 8 September 2004; online publish-ahead-of-print 30 November 2004.
* Corresponding author. Tel: +49 6131 175169; fax: +49 6131 175691. E-mail address: schnabelr{at}web.de
See page 207 for the editorial comment on this article (doi:10.1093/eurheartj/ehi078)
Aims N-terminal-pro-brain natriuretic peptide (Nt-proBNP) is a reliable risk predictor in acute coronary artery disease (CAD). Little is known about patients with stable angina pectoris (SAP). We aimed to investigate the prognostic impact of Nt-proBNP in a population with CAD especially focussing on patients with SAP.
Methods and results We obtained baseline samples from a prospective cohort of 904 consecutive patients with CAD. Cardiovascular events were registered during follow-up (median 2 years; maximum 3.7 years). Baseline Nt-proBNP was significantly higher among individuals with cardiovascular events compared with those without (711.5 vs. 238.8 pg/mL; P<0.0001). A similar association was found if the analysis was performed in patients who presented with stable angina (330 vs. 166.5 pg/mL; P=0.006) or acute coronary syndrome (990.9 vs. 527.7 pg/mL; P=0.03). In the SAP group, patients within the top quartile (>487.9 pg/mL) had a 3.7-fold (95% CI 1.2–9.1; P=0.01) increase in cardiovascular risk. After adjustment for most potential confounders including left ventricular ejection fraction, Nt-proBNP remained predictive for patients with serum concentrations in the upper quartile in comparison with patients in the lowest quartile (hazard ratio highest vs. lowest quartile: 4.0; P=0.03) (n=417).
Conclusion Baseline concentration of Nt-proBNP is independently related to future cardiovascular events in patients with stable angina.
Key Words: Nt-proBNP • hs-CRP • Stable angina pectoris • Coronary artery disease • Risk stratification • Multi-marker strategy
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