B-type natriuretic peptide is a long-term predictor of all-cause mortality, whereas high-sensitive C-reactive protein predicts recurrent short-term troponin T positive cardiac events in chest pain patients: a prognostic study

doi:10.1186/1471-2261-8-34

BMC Cardiovascular Disorders
Volume 8

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Brügger-Andersen T
Pönitz V
Staines H
Pritchard D
Grundt H
Nilsen DW

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Nilsen DW
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Research article

B-type natriuretic peptide is a long-term predictor of all-cause mortality, whereas high-sensitive C-reactive protein predicts recurrent short-term troponin T positive cardiac events in chest pain patients: a prognostic study

Trygve Brügger-Andersen¹^,2 , Volker Pönitz¹^,2 , Harry Staines³ , David Pritchard⁴ , Heidi Grundt¹^,2 and Dennis WT Nilsen¹^,2

¹Institute of Medicine, University of Bergen, Bergen, Norway

²Department of Medicine, Stavanger University Hospital, Stavanger, Norway

³Sigma Statistical Services, Balmullo, UK

⁴Axis-Shield, Dundee, UK

author email corresponding author email

BMC Cardiovascular Disorders 2008, 8:34doi:10.1186/1471-2261-8-34


Published:	25 November 2008

Abstract

Background

Few studies have addressed whether the combined use of B-type natriuretic peptide (BNP) and high-sensitive C-reactive protein (hsCRP) improves risk stratification for mortality and cardiovascular events in a population with chest pain and suspected acute coronary syndromes (ACS). Therefore, we wanted to assess the incremental prognostic value of these biomarkers with respect to long-term all-cause mortality and recurrent troponin T (TnT) positive cardiac events in 871 patients admitted to the emergency department.

Methods

Blood samples were obtained immediately following admission.

Results

After a follow-up period of 24 months, 129 patients had died. The BNP levels were significantly higher among patients dying than in long-term survivors (401 (145–736) versus 75 (29–235) pq/mL [median, 25 and 75% percentiles], p = 0.000). In a multivariable Cox regression model for death within 2 years, the hazard ratio (HR) for BNP in the highest quartile (Q4) was 5.13 (95% confidence interval (CI), 1.97–13.38) compared to the lowest quartile (Q1) and was associated with all-cause mortality above and beyond age, congestive heart failure and the index diagnosis ST-segment elevation myocardial infarction. HsCRP rendered no prognostic information for all-cause mortality. However, within 30 days, the adjusted HR for patients with recurrent TnT cardiac positive events hsCRP in Q4 was 14.79 (95% CI, 1.89–115.63) compared with Q1 and was associated with recurrent ischemic events above and beyond age, hypercholesterolemia and TnT values at admission.

Conclusion

BNP may act as a clinically useful biomarker when obtained at admission in an unselected patient population following hospitalization with chest pain and potential ACS, and may provide complementary prognostic information to established risk determinants at long-term follow-up. Our data do not support the hypothesis that the additional assessment of hsCRP will lead to better risk stratification for survival than BNP alone.

Trial registration

NCT00521976