B-type natriuretic peptide and high sensitive C-reactive protein predict 2-year all cause mortality in chest pain patients: a prospective observational study from Salta, Argentina

Abstract

BackgroundSeveral mechanisms are involved in the pathophysiology of the Acute Coronary Syndrome (ACS). We have addressed whether B-type natriuretic peptide (BNP) and high-sensitive C-reactive protein (hsCRP) in admission samples may improve risk stratification in chest pain patients with suspected ACS.MethodsWe included 982 patients consecutively admitted with chest pain and suspected ACS at nine hospitals in Salta, Northern Argentina. Total and cardiac mortality were recorded during a 2-year follow up period. Patients were divided into quartiles according to BNP and hsCRP levels, respectively, and inter quartile differences in mortality were statistically evaluated applying univariate and multivariate analyses.Results119 patients died, and the BNP and hsCRP levels were significantly higher among these patients than in survivors. In a multivariable Cox regression model for total death and cardiac death in all patients, the hazard ratio (HR) in the highest quartile (Q4) as compared to the lowest quartile (Q1) of BNP was 2.32 (95% confidence interval (CI), 1.24-4.35), p = 0.009 and 3.34 (95% CI, 1.26-8.85), p = 0.015, respectively. In the TnT positive patients (TnT > 0.01 ng/mL), the HR for total death and cardiac death in Q4 as compared to Q1 was 2.12 (95% CI, 1.07-4.18), p = 0.031 and 3.42 (95% CI, 1.13-10.32), p = 0.029, respectively.The HR for total death for hsCRP in Q4 as compared to Q1 was 1.97 (95% CI, 1.17-3.32), p = 0.011, but this biomarker did not predict cardiac death (p = 0.21). No prognostic impact of these two biomarkers was found in the TnT negative patients.ConclusionBNP and hsCRP may act as clinically useful biomarkers when obtained at admission in a population with suspected ACS.Trial RegistrationClinicalTrials.gov Identifier: NCT01377402.

Socioeconomic Assessment and Impact of Social Security on Outcome in Patients Admitted with Suspected Coronary Chest Pain in the City of Salta, Argentina

“…The details of the ARgentinean Risk Assessment Registry in the Acute Coronary Syndrome; the “ARRA-RACS Study” (ClinicalTrial.gov   NCT01377402), have been published previously [4, 5]. Briefly, the study was performed at nine hospitals in the city of Salta, northern Argentina, including the public hospital and eight of the eleven private clinics.…”

“…Secondary outcomes included cardiac death and SCD, as previously described [4]. Main exclusion criteria were age <18 years, unwillingness or incapacity to provide informed consent, and prior inclusion in the present study.…”

“…Main exclusion criteria were age <18 years, unwillingness or incapacity to provide informed consent, and prior inclusion in the present study. Baseline characteristics and clinical parameters of the total population have previously been described [4]. …”

“…The study was approved by the Ethics Committee at the Board of Medical School of Salta and at the local institutions [4] and was conducted in accordance with the Helsinki Declaration of 1971, as revised in 1983. The study was also approved by the Norwegian Authorities and was monitored by Stavanger Health Research, Stavanger, Norway.…”

Fatal and Non-fatal Spontaneous and Iatrogenic Acute Aortic Dissection type A: Report of two cases

“…Biomarkers: Recently, from our group, Linssen et al demonstrated that plasma N-terminal pro-Brain-type natriuretic peptide (NT-proBNP) independently predicted all-cause mortality and cardiovascular events in the general population [34] . In contrast to C-reactive protein (CRP), BNP is a marker of specific pathophysiological processes, especially in relation to ventricular dysfunction and ischemic burden [35]. Many supplementary biomarkers (CRP, D-dimer, NT-proBNP) could be helpful in early diagnosis and rapid classification of acute chest pain guiding management and predicting the prognosis [36] .…”