High-sensitivity C-reactive protein and N-terminal pro-B-type natriuretic peptide in patients with stable coronary artery disease: a prognostic study within the CLARICOR Trial

Marina J Harutyunyan, Anders Bruun Mathiasen, Per Winkel, Jens Peter Gøtze, Jørgen Fischer Hansen, Per Hildebrandt, Gorm Boje Jensen, Jørgen Hilden, Christian M Jespersen, Erik Kjøller, Hans J Kolmos, Christian Nyfeldt Gluud, Jens Kastrup

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Abstrakt

Abstract Background. Patients with stable coronary artery disease (CAD) have a poor prognosis. The aim of the study was to evaluate the extent to which serum high-sensitivity C-reactive protein (hs-CRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurement alone or together could be prognostic biomarkers in patients with stable CAD. Materials and methods. During the 2.6-year follow-up period 270 patients among the 4264 patients with stable CAD in the CLARICOR trial suffered myocardial infarction (MI) and 377 died (187 cardiovascular deaths (CVD)). Results. Serum NT-proBNP was significantly associated with MI (hazard ratio (HR), 1. 65 (refers to a 2.72 fold increase in serum level, p = 0.0005), CVD (HR, 2.42, p <0.0005) and non-CVD (HR, 1.79, p <0.0005). When correcting for hs-CRP, NT-proBNP was still significantly associated with MI (HR, 1.63, p = 0.0005), CVD (HR, 2.36, p <0.0005) and non-CVD (HR, 1.66, p <0.0005). Serum hs-CRP was compared to NT-proBNP less associated with MI (HR, 1.20, p = 0.001), CVD (HR, 1.39, p <0.0005) and non-CVD (HR, 1.67, p <0.0005). When corrected for NT-proBNP, hs-CRP was only associated with non-CVD (HR, 1.51, p <0.0005). When adjusting for cardiovascular risk factors hs-CRP predicted non-CVD (HR, 1.46) and all-cause death (HR, 1.24) and NT-proBNP predicted MI (HR, 1.50), CVD (HR, 1.98), non-CVD (HR, 1.39), and all-cause death (HR, 1.62)(p <0.0005 for all). Conclusion. Increased serum NT-proBNP was a stronger predictor of MI, cardiovascular death and non-cardiovascular death than hs-CRP in patients with stable CAD. Once NT-proBNP was taken into account, hs-CRP did not improve predictions.
OriginalsprogEngelsk
BogserieScandinavian Journal of Clinical and Laboratory Investigation. Supplement
Vol/bind71
Udgave nummer1
Sider (fra-til)52-62
Antal sider11
ISSN0085-591X
DOI
StatusUdgivet - 2011

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