Prognostic Value of N-Terminal Pro-B-Type Natriuretic Peptide and High-Sensitivity C-Reactive Protein in Patients With Previous Myocardial Infarction.

Ye-Xuan Cao,Jian-Jun Li,Ke-Fei Dou,Meng Zhang,Qian Dong,Sha Li,Yuan-Lin Guo,Na-Qiong Wu,Cheng-Gang Zhu,Jing Sun,Hui-Hui Liu

doi:10.3389/fcvm.2022.797297

Abstract

BackgroundPatients with previous myocardial infarction (MI) have a poor prognosis and stratification for recurrent major adverse cardiovascular events (MACE) among these patients is of considerable interest. N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hs-CRP) are considered to be potential cardiovascular risk factors, but less is known about their prognostic importance in post-MI patients. This study aimed to evaluate the prognostic value of NT-proBNP and hs-CRP alone or together in patients who reported a prior MI.MethodsIn this prospective study, we consecutively enrolled 3,306 post-MI patients to assess the recurrent MACE. The predictive values of NT-proBNP and hs-CRP alone and together were assessed by multivariable Cox regression using hazard ratios (HR) and 95% confidence intervals (CI).ResultsDuring the 4-year follow-up period, 335 patients developed recurrent MACE. Multivariate Cox regression analysis showed a significant correlation between NT-proBNP levels and MACE (HR: 2.99, 95%CI: 2.06–4.36, p < 0.001), hard endpoints (HR: 5.44, 95%CI: 2.99–9.90, p < 0.001), cardiac mortality (HR: 5.92, 95%CI: 2.34–14.96, p < 0.001) and all-cause mortality (HR: 5.03, 95%CI: 2.51–10.09, p < 0.001). However, hs-CRP was not an independent predictor after adjusting for NT-proBNP. When patients were divided into six groups by using tertiles values of NT-proBNP and median values of hsCRP, patients with high NT-proBNP/hs-CRP values were 3.27 times more likely to experience MACE than patients with low NT-proBNP/hs-CRP values. The addition of NT-proBNP and hs-CRP to a prognostic model revealed a significant improvement in C-statistic, net reclassification, and integrated discrimination.ConclusionsIncreased NT-proBNP levels were associated with long-term worse outcomes and the combination of NT-proBNP and hs-CRP has an incremental value in the further risk stratification of post-MI patients.

Highlights

Despite the development of effective preventive measures, coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide currently [1]
NTproBNP is the preferred biomarker for heart failure (HF), a number of studies have suggested that NT-proBNP is a risk marker to predict major adverse cardiovascular events (MACE) in the general population and in patients with CAD [7–9]
The event group had a higher proportion of hypertension and diabetes, and higher levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), HbA1c, hsCRP, and NT-proBNP compared with non-event group

Summary

Introduction

Despite the development of effective preventive measures, coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide currently [1]. Recent research has concentrated on identifying biomarkers which could be used to identify high-risk population and reliably predict prognosis [3]. In this regard, N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hs-CRP) are of considerable interest. NTproBNP is the preferred biomarker for heart failure (HF), a number of studies have suggested that NT-proBNP is a risk marker to predict major adverse cardiovascular events (MACE) in the general population and in patients with CAD [7–9]. N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hs-CRP) are considered to be potential cardiovascular risk factors, but less is known about their prognostic importance in post-MI patients.

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