Head-to-Head Comparison of the Incremental Predictive Value of The Three Established Risk Markers, Hs-troponin I, C-Reactive Protein, and NT-proBNP, in Coronary Artery Disease

Nikorowitsch, Julius; Ojeda, Francisco; Lackner, Karl J.; Schnabel, Renate B.; Blankenberg, Stefan; Zeller, Tanja; Karakas, Mahir

doi:10.3390/biom10030394

Cited by 11 publications

(5 citation statements)

References 26 publications

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“…Our findings regarding hs-cTnT and NT-proBNP levels are supported by results from the Ludwigshafen Risk and Cardiovascular Health (LURIC) study [25][26][27] and the AtheroGene cohort study [28]. However, the AtheroGene cohort study described CRP as an appropriate biomarker in this context, whereas in our observations, this was only true for the univariate analysis.…”

Section: Discussionsupporting

confidence: 78%

Biomarkers for Non-Invasive Stratification of Coronary Artery Disease and Prognostic Impact on Long-Term Survival in Patients with Stable Coronary Heart Disease

et al. 2022

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Knowledge about cardiac and inflammatory biomarkers in patients with stable coronary artery disease (CAD) is limited. To address this, we analyzed 3072 patients (36% female) with a median follow-up of 10 years in the Leipzig LIFE Heart Study with suspected CAD with coronary angiography. Selected biomarkers included troponin T (hsTNT), N-terminal pro B-type natriuretic peptide (NT-proBNP), copeptin, C-reactive protein (hsCRP), and interleukin-6 (IL-6). Patients were stratified by CAD severity: CAD0 (no sclerosis), CAD1 (non-obstructive, i.e., stenosis < 50%), and CAD2 (≥one stenosis ≥ 50%). Group comparison (GC) included GC1: CAD0 + 1 vs. CAD2; GC2: CAD0 vs. CAD1 + 2. CAD0, CAD1, and CAD2 were apparent in 1271, 631, and 1170 patients, respectively. Adjusted for classical risk factors, hs-cTnT, NT-proBNP, and IL-6 differed significantly in both GC and hsCRP only in GC2. After multivariate analysis, hs-cTnT, NT-proBNP, and IL-6 remained significant in GC1. In GC2, hs-cTnT (p < 0.001) and copeptin (p = 0.014) reached significance. Ten-year survival in groups CAD0, CAD1, and CAD2 was 88.3%, 77.3%, and 72.4%. Incorporation of hs-cTnT, NT-proBNP, copeptin, and IL-6 improved risk prediction (p < 0.001). The studied cardiac and inflammatory biomarkers enable fast and precise non-invasive identification of mortality risk in CAD patients, allowing the tailoring of primary and secondary CAD prevention.

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Section: Discussionsupporting

confidence: 78%

Biomarkers for Non-Invasive Stratification of Coronary Artery Disease and Prognostic Impact on Long-Term Survival in Patients with Stable Coronary Heart Disease

et al. 2022

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“…Our results were in line with previous studies that once NT- proBNP was taken into account, hs-CRP did not improve predictions in patients with CAD ( 29 , 30 ). Recently, Nikorowitsch et al ( 19 ) performed a head-to-head comparison between NT-proBNP and hs-CRP in patients with CAD and found that NT-proBNP yielded additional prognostic value beyond hs-CRP. Accordingly, our findings might suggest that NT-proBNP levels may outperform hs-CRP in risk estimation.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with CAD, a multi-marker approach to risk stratification has allowed a powerful short-and long-term prediction of heightened risk of MACE (18)(19)(20)(21). Although information available indicates that NT-proBNP and hs-CRP might provide unique prognostic information in patients with previous MI, no study so far has assessed whether combined use of these biomarkers could improve the risk stratification.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Value of N-Terminal Pro-B-Type Natriuretic Peptide and High-Sensitivity C-Reactive Protein in Patients With Previous Myocardial Infarction

Cao

Liu

et al. 2022

Front. Cardiovasc. Med.

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BackgroundPatients with previous myocardial infarction (MI) have a poor prognosis and stratification for recurrent major adverse cardiovascular events (MACE) among these patients is of considerable interest. N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hs-CRP) are considered to be potential cardiovascular risk factors, but less is known about their prognostic importance in post-MI patients. This study aimed to evaluate the prognostic value of NT-proBNP and hs-CRP alone or together in patients who reported a prior MI.MethodsIn this prospective study, we consecutively enrolled 3,306 post-MI patients to assess the recurrent MACE. The predictive values of NT-proBNP and hs-CRP alone and together were assessed by multivariable Cox regression using hazard ratios (HR) and 95% confidence intervals (CI).ResultsDuring the 4-year follow-up period, 335 patients developed recurrent MACE. Multivariate Cox regression analysis showed a significant correlation between NT-proBNP levels and MACE (HR: 2.99, 95%CI: 2.06–4.36, p < 0.001), hard endpoints (HR: 5.44, 95%CI: 2.99–9.90, p < 0.001), cardiac mortality (HR: 5.92, 95%CI: 2.34–14.96, p < 0.001) and all-cause mortality (HR: 5.03, 95%CI: 2.51–10.09, p < 0.001). However, hs-CRP was not an independent predictor after adjusting for NT-proBNP. When patients were divided into six groups by using tertiles values of NT-proBNP and median values of hsCRP, patients with high NT-proBNP/hs-CRP values were 3.27 times more likely to experience MACE than patients with low NT-proBNP/hs-CRP values. The addition of NT-proBNP and hs-CRP to a prognostic model revealed a significant improvement in C-statistic, net reclassification, and integrated discrimination.ConclusionsIncreased NT-proBNP levels were associated with long-term worse outcomes and the combination of NT-proBNP and hs-CRP has an incremental value in the further risk stratification of post-MI patients.

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“…NT-proBNP concentrations are also included as a criterion to enter contemporary clinical trials for HF and serve as a proxy metric to demonstrate the effect of interventions on HF morbidity and mortality [ 10 ]. Previous studies have compared cardiac troponins and NT-proBNP “head-to-head” as prognostic markers in patients with coronary heart disease [ 11 ], elderly hospitalized patients [ 12 ], and patients with cardiogenic stroke [ 13 ]. In contrast, less is known about the different properties of cardiac troponin and NT-proBNP in predicting short-term prognosis in unselected patients with acute dyspnea.…”

Section: Introductionmentioning

confidence: 99%

Cardiac Troponin T and NT-proBNP for Prediction of 30-Day Readmission or Death in Patients with Acute Dyspnea: Data from the Akershus Cardiac Examination 2 Study

Bhatnagar,

Berge,

Røysland

et al. 2023

Cardiology

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Introduction: N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin T (cTnT) measurements are recommended in patients with acute dyspnea. We aimed to assess the prognostic merit of cTnT compared to NT-proBNP for 30-day readmission or death in patients hospitalized with acute dyspnea. Methods: We measured cTnT and NT-proBNP within 24 hours in 314 patients hospitalized with acute dyspnea and adjudicated the cause of the index admission. Time to first event of readmission or death ≤30 days after hospital discharge was recorded and cTnT and NT-proBNP measurements were compared head-to-head. Results: Five patients died during the index admission and were excluded from the study. Patients who died (7/309) or were readmitted (71/309) within 30 days had higher cTnT concentrations (median 29.1, Q1-Q3 18.2-73.9 ng/L) compared to patient who survived and were not readmitted (median 19.4, Q1-Q3 8.4-36.1 ng/L; p <0.001). There were no statistically significant differences in NT proBNP concentrations when stratifying patients according to readmission or death within 30 days: median 1540.6, Q1-Q3 424-5571 ng/L vs. median 984, Q1-Q3 201-3600 (p = 0.07). cTnT concentrations separated patients with poor and favorable outcomes, both for the total cohort and for patients with adjudicated heart failure (HF). cTnT concentrations were associated with readmission or death within 30 days after discharge, both in the total cohort (adjusted hazard ratio [aHR] 1.65, 95% CI 1.30-2.08) and in patients with HF (aHR 1.60, 95% CI 1.15-2.24). In contrast, NT-proBNP concentrations were not associated with prognosis in the total cohort (aHR 1.11, 95% CI 0.94-1.31) or in patients with adjudicated HF (aHR 1.03, 95% CI 0.78-1.37). In the subgroup analysis of HF patients, where patients with acute HF were grouped according to LVEF (HFpEF and HFrEF), cTnT and NT proBNP did not predict short-term outcomes for HFrEF, but cTnT predicted short-term outcomes in HFpEF patients. Conclusions: cTnT concentrations associate with post-discharge 30-day readmission or death in patients hospitalized with acute dyspnea, as well as in in patients adjudicated HF. The association of cTnT with outcomes in HF appears driven by strong associations of cTnT in patients with HFpEF.

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Head-to-Head Comparison of the Incremental Predictive Value of The Three Established Risk Markers, Hs-troponin I, C-Reactive Protein, and NT-proBNP, in Coronary Artery Disease

Cited by 11 publications

References 26 publications

Biomarkers for Non-Invasive Stratification of Coronary Artery Disease and Prognostic Impact on Long-Term Survival in Patients with Stable Coronary Heart Disease

Biomarkers for Non-Invasive Stratification of Coronary Artery Disease and Prognostic Impact on Long-Term Survival in Patients with Stable Coronary Heart Disease

Prognostic Value of N-Terminal Pro-B-Type Natriuretic Peptide and High-Sensitivity C-Reactive Protein in Patients With Previous Myocardial Infarction

Cardiac Troponin T and NT-proBNP for Prediction of 30-Day Readmission or Death in Patients with Acute Dyspnea: Data from the Akershus Cardiac Examination 2 Study

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