Key result
Patients with acute coronary syndrome and elevated levels of both hs-CRP (>3.5 mg/L) and NT-proBNP (>500 pg/ml) had an 11.8-fold higher risk of cardiac events compared to those without elevations.
Why the study?
Do baseline levels of hs-CRP and NT-proBNP predict cardiac events in patients with acute coronary syndrome?
Cohort (n=215)
No
Do baseline levels of hs-CRP and NT-proBNP predict cardiac events in patients with acute coronary syndrome?
Effect estimate: HR 11.8 (95% CI 1.4-98.8)
p-value: p=0.023
Elevated baseline levels of both hs-CRP and NT-proBNP identify acute coronary syndrome patients at a significantly higher risk for subsequent cardiac events.
May aid ACS risk stratification; hypothesis-generating and requires prospective validation before guiding care.
BACKGROUND: Cardiac biomarkers, including high-sensitivity C-reactive protein (hs-CRP), N-terminal proB-type natriuretic peptide (NT-proBNP) and cardiac troponin-I (Tn-I), have been associated with an adverse outcome in patients with acute coronary syndrome (ACS). Thus, in the present study the incremental prognostic value of these cardiac biomarkers was evaluated for risk stratification of ACS. METHODS AND RESULTS: The baseline levels of hs-CRP, NT-proBNP and Tn-I were measured in 215 patients (140 males; 65+/-46 years) with ACS: ST-elevation myocardial infarction (STEMI): 56; non-ST-elevation myocardial infarction (NSTEMI): 98; unstable angina (UA): 61. The patients were retrospectively followed up for a mean of 246 days. There were 24 cardiac events: STEMI: 1, NSTEMI: 6, UA: 6, chronic heart failure: 1, death: 10. The baseline levels of hs-CRP and NT-proBNP were significantly higher in the patients with cardiac events than in those without events. After adjustment for major clinical prognostic factors, hs-CRP and NT-proBNP remained significantly independent predictors for cardiac events. Patients with hs-CRP level >3.5 mg/L and NT-proBNP level >500 pg/ml had an 11-fold higher risk for cardiac events than those with hs-CRP level <or=3.5 mg/L and NT-proBNP level <or=500 pg/ml. CONCLUSION: The combination of both cardiac markers has an incremental value in the risk stratification of patients with ACS.
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Kim et al. (2006) conducted a cohort in Acute Coronary Syndrome (n=215). Elevated hs-CRP (>3.5 mg/L) and NT-proBNP (>500 pg/ml) vs. hs-CRP ≤3.5 mg/L and NT-proBNP ≤500 pg/ml was evaluated on Major adverse cardiac events (cardiac death, new or recurrent MI, rehospitalization for worsening UA, and new or worsening CHF) (HR 11.8, 95% CI 1.4-98.8, p=0.023). Patients with acute coronary syndrome and elevated levels of both hs-CRP (>3.5 mg/L) and NT-proBNP (>500 pg/ml) had an 11.8-fold higher risk of cardiac events compared to those without elevations.
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