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Clin Chem. 2014 Nov;60(11):1441-9. doi: 10.1373/clinchem.2013.220202. Epub 2014 Aug 19.

Prognostic value of midregional pro-A-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide in patients with stable coronary heart disease followed over 8 years.

Author information

1
Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Ulm, Germany;
2
Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany;
3
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
4
Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Ulm, Germany; wolfgang.koenig@uniklinik-ulm.de.
5
Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.

Abstract

BACKGROUND:

Pathophysiological studies suggest that A-type natriuretic peptides (ANPs) might provide valuable information beyond B-type natriuretic peptides (BNPs) about cardiac dysfunction in patients with coronary heart disease (CHD). We aimed to assess the predictive value of midregional pro-A-type natriuretic peptide (MR-proANP) for recurrent cardiovascular disease (CVD) events in stable CHD patients for whom information on N-terminal proBNP (NT-proBNP) was already available.

METHODS:

Plasma concentrations of MR-proANP and NT-proBNP were measured at baseline in a cohort of 1048 patients aged 30-70 years with CHD who were participating in an in-hospital rehabilitation program. Main outcome measures were cardiovascular mortality, nonfatal myocardial infarction, and nonfatal stroke.

RESULTS:

During a median follow-up of 8.1 years, 150 patients (incidence 21.1 per 1000 patient-years) experienced a secondary CVD event. MR-proANP was associated with a hazard ratio (HR) of 1.89 (95% CI, 1.01-3.57) when the top quartile was compared to the bottom quartile in the fully adjusted model (P for trend = 0.011). For NT-proBNP the respective HR was 2.22 (95% CI, 1.19-4.14) with a P for trend = 0.001. Finally, MR-proANP improved various model performance measures, including c-statistics and reclassification metrics, but without being superior to NT-proBNP.

CONCLUSIONS:

Although we found an independent association of MR-proANP as well as NT-proBNP when used as single markers with recurrent CVD events after adjustment for established risk factors, the results of a simultaneous assessment of both markers indicated that MR-proANP fails to provide additional prognostic information to NT-proBNP in the population studied.

PMID:
25139456
DOI:
10.1373/clinchem.2013.220202
[Indexed for MEDLINE]
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