Clin Chem Lab Med. 2013 Oct;51(10):2019-28. doi: 10.1515/cclm-2012-0786.
The simultaneous assessment of high-sensitivity cardiac troponin T (hscTnT) and NT-proBNP for predicting death in stable coronary artery disease (CAD) has yet not been examined. We investigated the additional contribution of hscTnT to the risk of mortality prediction of NT-proBNP in patients with stable CAD.
We studied 1469 patients with stable CAD enrolled in the Ludwigshafen Risk and Cardiovascular Health Study (LURIC). hscTnT and NT-proBNP were measured in baseline samples using immunoassays (Roche Diagnostics, Germany).
Thirty-five percent (n=525) of the patients died during a median follow-up of 7 and a half years. In total 59.0% of the non-survivors and 25.2% of the survivors exhibited concentrations of hscTnT≥14 ng/L. Logistic regression analysis identified hscTnT and NT-proBNP as independent risk markers for short-term (1-year follow-up) and long-term (9-years follow-up) mortality. ROC curve analysis determined optimal univariate cut-offs at 14 ng/L and 443 µg/L for hscTnT (AUC 0.725, p<0.0001) and NT-proBNP (AUC 0.742, p<0.0001), respectively. Kaplan-Meier survival analysis based on optimized cut-offs for the simultaneous determination of both biomarkers confirmed the usefulness of additive hscTnT especially in prediction of short-term mortality. The prognostic benefit of the combined assessment of hscTnT and NT-proBNP could be confirmed by a significantly increased reclassification index (NRI) of 24.2%.
The majority of non-survivors exhibited increased hscTnT concentrations above 14 ng/L. The simultaneous determination of NT-proBNP and hscTnT was superior for risk stratification compared to determining either marker alone. Especially the prediction of the clinically important 1-year mortality was significantly improved by addition of hscTnT to NT-proBNP.
同时评估高敏心肌肌钙蛋白 T（hscTnT）和 NT-proBNP 以预测稳定型冠状动脉疾病（CAD）患者的死亡尚未得到研究。我们研究了 hscTnT 对稳定型 CAD 患者 NT-proBNP 死亡率预测风险的额外贡献。
我们研究了 1469 例稳定型 CAD 患者，他们参加了路德维希港风险和心血管健康研究（LURIC）。使用免疫分析法（罗氏诊断公司，德国）在基线样本中测量 hscTnT 和 NT-proBNP。
在中位随访 7 年半的时间里，35%（n=525）的患者死亡。在所有非幸存者中，59.0%和幸存者中 25.2%的人 hscTnT 浓度≥14ng/L。Logistic 回归分析确定 hscTnT 和 NT-proBNP 是短期（1 年随访）和长期（9 年随访）死亡率的独立风险标志物。ROC 曲线分析确定了 hscTnT 的最佳单变量截止值为 14ng/L（AUC 0.725，p<0.0001）和 NT-proBNP 的最佳单变量截止值为 443μg/L（AUC 0.742，p<0.0001）。基于优化两种生物标志物的截止值进行的 Kaplan-Meier 生存分析证实了 hscTnT 的有用性，尤其是在短期死亡率预测方面。hscTnT 和 NT-proBNP 联合评估的预后获益可以通过显著增加的重新分类指数（NRI）24.2%来证实。
大多数非幸存者的 hscTnT 浓度高于 14ng/L。与单独测定任何一种标志物相比，同时测定 NT-proBNP 和 hscTnT 对风险分层更优。特别是通过将 hscTnT 添加到 NT-proBNP 中，对临床重要的 1 年死亡率的预测得到了显著改善。
