Ndrepepa, G; Kastrati, A; Braun, S; Mehilli, J; Niemöller, K; von Beckerath, N; von Beckerath, O; Vogt, W; Schömig, A
N-terminal probrain natriuretic peptide and C-reactive protein in stable coronary heart disease.
PURPOSE: C-reactive protein (CRP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) provide prognostic information in patients with stable coronary heart disease. The aim of the study was to investigate whether combined use of NT-proBNP and CRP improves risk stratification in these patients. METHODS: This cohort study included 989 patients with stable coronary heart disease who underwent coronary stenting. CRP and NT-proBNP were measured before angiography. The primary end point of the study was all-cause mortality. Using median values of NT-proBNP (279.9 ng/L) and CRP (1.2 mg/L), patients were divided into 4 groups: low NT-proBNP-low CRP group (305 patients with NT-proBNP or =median; high NT-proBNP-low CRP group (237 patients with NT-proBNP> or =median and CRP or =median and CRP> or =median). RESULTS: During a median follow-up of 3.6 years (interquartile range 3.3 to 4.5 years), there were 85 deaths: 6 deaths in the low NT-proBNP-low CRP group, 11 deaths in the low NT-proBNP-high CRP group, 20 deaths in the high NT-proBNP-low CRP group, and 48 deaths in the high NT-proBNP-high CRP group with Kaplan-Meier mortality estimates of 2.7%, 8.9%, 12.1% and 35.6%, respectively (P<.001). Cox proportional hazards model showed that combination NT-proBNP-CRP was the strongest independent correlate of mortality (hazard ratio [HR] 4.3, 95% confidence interval [CI], 2.0-9.3; P<.001 for high NT-proBNP-high CRP vs low NT-proBNP-low CRP). CONCLUSION: Combined use of NT-proBNP and CRP improves long-term risk prediction of mortality in patients with stable coronary heart disease.