Details

Autor(en) / Beteiligte

• Sinning, Christoph, MD
• Ojeda, Francisco, PhD
• Zeller, Tanja, PhD
• Zengin, Elvin, MD
• Rupprecht, Hans-J., MD
• Lackner, Karl-J., MD
• Bickel, Christoph, MD
• Blankenberg, Stefan, MD
• Schnabel, Renate B., MD
• Westermann, Dirk, MD

Titel

Cardiovascular mortality in chest pain patients – Comparison of natriuretic peptides to novel biomarkers of cardiovascular stress

Ist Teil von

• Canadian journal of cardiology, 2015

Erscheinungsjahr

2015

Quelle

Elsevier ScienceDirect Journals

Beschreibungen/Notizen

• Abstract Background Natriuretic peptides are the standard biomarker for risk stratification in cardiovascular disease. Novel biomarkers of cardiovascular stress might allow refinement in risk stratification for patients with ACS. We tested the performance of these novel biomarkers for cardiovascular risk stratification in patients presenting with ACS. Methods In the Athero Gene study, 873 patients presented with ACS in the emergency department (ED). Biomarkers measured were: B-type natriuretic peptide (BNP), N-terminal pro B-type natriuretic peptide (NT-proBNP), midregional pro-atrial natriuretic peptide (MR-proANP), midregional proadrenomedullin (MR-proADM), copeptin, and troponin I (TnI). The median follow-up time was 4 years and during this time 50 patients died of cardiac causes. Results Cox-Regression analysis for the continuous variable NT-proBNP and BNP showed a hazard ratio (HR) of 1.9 and 1.8 for one standard deviation increase respectively (p<0.001 and p=0.003) in the fully adjusted model. Novel biomarkers with MR-proADM had an HR of 3.2, followed by MR-proANP with an HR=1.9 (both p<0.001) and copeptin with an HR=1.6 (p<0.001). C-index revealed MR-proADM as the best discriminator for identifying patients with the outcome with a C-index=0.8, while C-index was 0.72 for NT-proBNP (p for comparison=0.017). Integrated discrimination improvement (IDI) for MR-proADM was 0.059 in comparison to NT-proBNP (p=0.016), thus providing background that MR-proADM was better to identify persons with the outcome. Troponin I levels at admission were not significant for risk stratification. Conclusion In patients presenting with ACS the novel biomarker, MR-proADM was the best predictor for outcome. MR-proADM adds modest information and is useful for risk prediction in ACS patients.