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KMID : 0882420090770020200
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Korean Journal of Medicine
2009 Volume.77 No. 2 p.200 ~ p.210
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The prognostic value of NT-proBNP, Troponin I, and hs-CRP in patients with acute coronary syndrome
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Oh Pyung-Chun
Han Seung-Hwan
Chung Wook-Jin
Kang Woong-Chol
Seo Yiel-Hea
Eom Young-Sil
Moon Chan-Il
Bong Jeong-Min
Shin Mi-Seung
Koh Kwang-Kon
Ahn Tae-Hoon
Choi In-Suck
Shin Eak-Kyun
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Abstract
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Background/Aims: Elevated levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), troponin I, and high-sensitivity C-reactive protein (hs-CRP) are each associated with higher rates of death and recurrent myocardial ischemia in patients with acute coronary syndrome (ACS). We evaluated the prognostic value of NT-proBNP and a multi-marker risk approach with the simultaneous assessment of NT-proBNP, troponin I, and hs-CRP in patients with ACS.
Methods: We included 277 patients who were admitted for ACS between January and December 2006. We measured NT-proBNP, troponin I, and hs-CRP within 24 hours of the onset of symptoms. Patients were followed for a median of 559 days for cardiovascular events, including death, new myocardial infarction, heart failure, or rehospitalization for ACS.
Results: NT-proBNP was the most powerful predictor of clinical outcome among the biomarkers (HR 3.65, 95% CI 2.11-6.30), followed by the peak troponin I and hs-CRP (HR 2.08, 95% CI 1.12-3.87; HR 1.99, 95% CI 1.18-3.37, respectively), but not the baseline troponin I. A multi-marker risk approach with the simultaneous assessment of NT-proBNP, hs-CRP, and peak troponin I was significantly associated with cardiovascular events, especially the presence of three positive biomarkers (adjusted HR 4.20, 95% CI 1.39-12.67).
Conclusions: NT-proBNP is the most powerful, independent predictor of clinical outcome among the cardiac biomarkers. Since the peak troponin I level provides more prognostic information than the baseline level, follow-up measurement of troponin I may be warranted for risk stratification. The multi-marker risk approach appears to have better prognostic performance than any marker in isolation.
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KEYWORD
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Acute coronary syndrome, Prognosis, NT-proBNP, Troponin I, C-reactive protein
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