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Clin Chem. 2017 Jul;63(7):1214-1226. doi: 10.1373/clinchem.2016.265272. Epub 2017 May 17.

Temporal Biomarker Profiling Reveals Longitudinal Changes in Risk of Death or Myocardial Infarction in Non-ST-Segment Elevation Acute Coronary Syndrome.

Author information

1
Department of Medicine, National University of Singapore; Singapore; mark_chan@nuhs.edu.sg.
2
Duke Clinical Research Institute, Durham, NC.
3
Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC.
4
St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
5
Department of Cardiology, Faculty of Medicine, Lund University, Lund, Sweden.
6
Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands.
7
Eli Lilly and Company, Indianapolis, IN.
8
Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
9
Canadian VIGOUR Centre and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
10
Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
11
Centre for Chronic Disease Control and Public Health Foundation of India, New Delhi, India.
12
The 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital and Sigmund Freud Private University, Medical School, Vienna, Austria.

Abstract

BACKGROUND:

There are conflicting data on whether changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hs-CRP) concentrations between time points (delta NT-proBNP and hs-CRP) are associated with a change in prognosis.

METHODS:

We measured NT-proBNP and hs-CRP at 3 time points in 1665 patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). Cox proportional hazards was applied to the delta between temporal measurements to determine the continuous association with cardiovascular events. Effect estimates for delta NT-proBNP and hs-CRP are presented per 40% increase as the basic unit of temporal change.

RESULTS:

Median NT-proBNP was 370.0 (25th, 75th percentiles, 130.0, 996.0), 340.0 (135.0, 875.0), and 267.0 (111.0, 684.0) ng/L; and median hs-CRP was 4.6 (1.7, 13.1), 1.9 (0.8, 4.5), and 1.8 (0.8, 4.4) mg/L at baseline, 30 days, and 6 months, respectively. The deltas between baseline and 6 months were the most prognostically informative. Every +40% increase of delta NT-proBNP (baseline to 6 months) was associated with a 14% greater risk of cardiovascular death (adjusted hazard ratio (HR) 1.14, 95% CI, 1.03-1.27) and with a 14% greater risk of all-cause death (adjusted HR 1.14, 95% CI, 1.04-1.26), while every +40% increase of delta hs-CRP (baseline to 6 months) was associated with a 9% greater risk of the composite end point (adjusted HR 1.09, 95% CI, 1.02-1.17) and a 10% greater risk of myocardial infarction (adjusted HR 1.10, 95%, CI 1.00-1.20).

CONCLUSIONS:

Temporal changes in NT-proBNP and hs-CRP are quantitatively associated with future cardiovascular events, supporting their role in dynamic risk stratification of NSTEACS.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov identifier NCT00699998.

PMID:
28515099
DOI:
10.1373/clinchem.2016.265272
[Indexed for MEDLINE]
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