The prognostic value of NT-proBNP, Troponin I, and hs-CRP in patients with acute coronary syndrome.
- Author:
Pyung Chun OH
1
;
Seung Hwan HAN
;
Wook Jin CHUNG
;
Woong Chol KANG
;
Yiel Hea SEO
;
Young Sil EOM
;
Chan Il MOON
;
Jeong Min BONG
;
Mi Seung SHIN
;
Kwang Kon KOH
;
Tae Hoon AHN
;
In Suck CHOI
;
Eak Kyun SHIN
Author Information
1. Division of Cardiology, Departments of Internal Medicine, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea. ekshin@gilhospital.com
- Publication Type:Original Article
- Keywords:
Acute coronary syndrome;
Prognosis;
NT-proBNP;
Troponin I;
C-reactive protein
- MeSH:
Acute Coronary Syndrome;
Biomarkers;
C-Reactive Protein;
Follow-Up Studies;
Heart Failure;
Humans;
Myocardial Infarction;
Myocardial Ischemia;
Natriuretic Peptide, Brain;
Peptide Fragments;
Prognosis;
Troponin;
Troponin I
- From:Korean Journal of Medicine
2009;77(2):200-210
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND/AIMS: Elevated levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), troponin I, and high-sensitivity C-reactive protein (hs-CRP) are each associated with higher rates of death and recurrent myocardial ischemia in patients with acute coronary syndrome (ACS). We evaluated the prognostic value of NT-proBNP and a multi-marker risk approach with the simultaneous assessment of NT-proBNP, troponin I, and hs-CRP in patients with ACS. METHODS: We included 277 patients who were admitted for ACS between January and December 2006. We measured NT-proBNP, troponin I, and hs-CRP within 24 hours of the onset of symptoms. Patients were followed for a median of 559 days for cardiovascular events, including death, new myocardial infarction, heart failure, or rehospitalization for ACS. RESULTS: NT-proBNP was the most powerful predictor of clinical outcome among the biomarkers (HR 3.65, 95% CI 2.11-6.30), followed by the peak troponin I and hs-CRP (HR 2.08, 95% CI 1.12-3.87;HR 1.99, 95% CI 1.18-3.37, respectively), but not the baseline troponin I. A multi-marker risk approach with the simultaneous assessment of NT-proBNP, hs-CRP, and peak troponin I was significantly associated with cardiovascular events, especially the presence of three positive biomarkers (adjusted HR 4.20, 95% CI 1.39-12.67). CONCLUSIONS: NT-proBNP is the most powerful, independent predictor of clinical outcome among the cardiac biomarkers. Since the peak troponin I level provides more prognostic information than the baseline level, follow-up measurement of troponin I may be warranted for risk stratification. The multi-marker risk approach appears to have better prognostic performance than any marker in isolation.
