Bode Edmund, Wuppinger Thomas, Bode Thomas, Alber Hannes, Ulmer Hanno, Pachinger Otmar, Mair Johannes
Department of Internal Medicine III-Cardiology, Innsbruck Medical University, Austria.
Coron Artery Dis. 2012 Mar;23(2):91-7. doi: 10.1097/MCA.0b013e32834f1165.
The aim of the study was to compare N-terminal pro B-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein, and gamma-glutamyl transferase (γ-GT) with traditional risk markers for estimating prognosis in patients with stable coronary artery disease (CAD).
Evaluation of mortality and a combined clinical endpoint (mortality, need for coronary revascularization, myocardial infarction, hospitalization for cardiac causes, or stroke) during an average 3.2-year follow-up in 394 consecutive patients (73% male patients, age: 67±9 years) with angiographically proven stable CAD.
Univariate Kaplan-Meier survival rate analysis showed that traditional risk markers, apart from impaired renal function, three-vessel CAD, and a reduced left ventricular function at the time of coronary angiography, were not of prognostic relevance for prediction of outcome. NT-proBNP, high-sensitivity C-reactive protein, and gamma-glutamyl transferase were significant predictors of mortality; however, only NT-proBNP was a significant predictor of the combined endpoint. In age-adjusted and sex-adjusted multivariate Cox regression analysis, NT-proBNP was the strongest independent predictor of the combined endpoint (odds ratio 2.92, 95% confidence interval: 1.72-4.94, first vs. third tertile). All three laboratory parameters remained independent risk markers for mortality in multivariate analysis. NT-proBNP, however, revealed the highest odds ratio (5.23, 95% confidence interval: 1.17-23.23, first vs. third tertile). Concentrations greater than 356 ng/l predicted mortality with a sensitivity of 70%, a specificity of 71%, a positive likelihood ratio of 2.4, and a negative likelihood ratio of 0.42.
In comparison with other tested novel biomarkers and traditional risk markers, NT-proBNP was the most predictive prognostic marker in multivariate analysis in patients with stable CAD.
本研究旨在比较N末端B型利钠肽原（NT-proBNP）、高敏C反应蛋白和γ-谷氨酰转移酶（γ-GT）与传统风险标志物，以评估稳定性冠心病（CAD）患者的预后。
对394例经血管造影证实为稳定性CAD的连续患者（73%为男性患者，年龄：67±9岁）进行平均3.2年的随访，评估死亡率和综合临床终点（死亡、冠状动脉血运重建需求、心肌梗死、因心脏原因住院或中风）。
单因素Kaplan-Meier生存率分析显示，除肾功能受损、三支血管CAD以及冠状动脉造影时左心室功能降低外，传统风险标志物对结局预测无预后相关性。NT-proBNP、高敏C反应蛋白和γ-谷氨酰转移酶是死亡率的显著预测因子；然而，只有NT-proBNP是综合终点的显著预测因子。在年龄和性别校正的多因素Cox回归分析中，NT-proBNP是综合终点最强的独立预测因子（比值比2.92，95%置信区间：1.72 - 4.94，第一三分位数与第三三分位数相比）。在多因素分析中，所有三个实验室参数仍是死亡率的独立风险标志物。然而，NT-proBNP显示出最高的比值比（5.23，95%置信区间：1.17 - 23.23，第一三分位数与第三三分位数相比）。浓度大于356 ng/l预测死亡率的敏感性为70%，特异性为71%，阳性似然比为2.4，阴性似然比为0.42。
与其他测试的新型生物标志物和传统风险标志物相比，NT-proBNP是稳定性CAD患者多因素分析中最具预测性的预后标志物。
