Serial measurements of N-terminal pro-brain natriuretic peptide in patients with coronary heart disease

• Published in: PloS one Vol. 10; no. 1; p. e0117143
• Main Authors: Dallmeier, Dhayana, Pencina, Michael J, Rajman, Iris, Koenig, Wolfgang, Rothenbacher, Dietrich, Brenner, Hermann
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 28.01.2015; Public Library of Science (PLoS)
• Subjects: Acute coronary syndromes; Aged; Analysis; Biomarkers; Biomarkers - blood; Biometrics; Brain; Brain natriuretic peptide; Brain research; Cardiac patients; Cardiology; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - blood; Cardiovascular Diseases - diagnosis; Coronary artery disease; Coronary Disease - blood; Coronary heart disease; Diabetes; Epidemiology; Family medical history; Female; Hazards; Health risk assessment; Health risks; Heart; Heart attacks; Heart diseases; Hospitals; Humans; Internal medicine; Ischemia; Male; Measurement; Measurement methods; Medical research; Middle Aged; Mortality; Natriuretic Peptide, Brain - blood; Natriuretic peptides; Older people; Patients; Peptide Fragments - blood; Peptides; Prognosis; Proteins; Reclassification; Rehabilitation; Risk analysis; Risk Assessment; Risk Factors; Statistical models
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0117143

To assess the prognostic value of 12-months N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP) levels on adverse cardiovascular events in patients with stable coronary heart disease. NT-proBNP concentrations were measured at baseline and at 12-months follow-up in participants of cardiac rehabilitation (median follow-up 8.96 years). Cox-proportional hazards models evaluated the prognostic value of log-transformed NT-proBNP levels, and of 12-months NT-proBNP relative changes on adverse cardiovascular events adjusting for established risk factors measured at baseline. Among 798 participants (84.7% men, mean age 59 years) there were 114 adverse cardiovascular events. 12-months NT-proBNP levels were higher than baseline levels in 60 patients (7.5%) and numerically more strongly associated with the outcome in multivariable analysis (HR 1.65 [95% CI 1.33-2.05] vs. HR 1.41 [95% CI 1.12-1.78], with a net reclassification improvement (NRI) of 0.098 [95% CI 0.002-0.194] compared to NRI of 0.047 [95% CI -0.0004-0.133] for baseline NT-proBNP levels. A 12-month 10% increment of NT-proBNP was associated with a HR of 1.35 [95% CI 1.12-1.63] for the onset of an adverse cardiovascular event. Subjects with a 12-month increment of NT-proBNP had a HR of 2.56 [95% CI 1.10-5.95] compared to those with the highest 12-months reduction. Twelve-months NT-proBNP levels after an acute cardiovascular event are strongly associated with a subsequent event and may provide numerically better reclassification of patients at risk for an adverse cardiovascular event compared to NT-proBNP baseline levels after adjustment for established risk factors.