Risk stratification in stable coronary artery disease
| Autor: | Hannes Alber, Hanno Ulmer, Edmund Bode, Johannes Mair, Thomas Wuppinger, Thomas Bode, Otmar Pachinger |
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| Rok vydání: | 2012 |
| Předmět: |
Male
medicine.medical_specialty medicine.drug_class Coronary Artery Disease Coronary Angiography Risk Assessment Severity of Illness Index Likelihood ratios in diagnostic testing Coronary artery disease Electrocardiography Risk Factors Surveys and Questionnaires Internal medicine Natriuretic Peptide Brain Clinical endpoint Natriuretic peptide Humans Medicine cardiovascular diseases Myocardial infarction Survival rate Aged Retrospective Studies business.industry Incidence gamma-Glutamyltransferase General Medicine Odds ratio Middle Aged Prognosis medicine.disease Peptide Fragments Confidence interval Survival Rate C-Reactive Protein ROC Curve Echocardiography Austria Disease Progression Cardiology Female Cardiology and Cardiovascular Medicine business Biomarkers Follow-Up Studies |
| Zdroj: | Coronary Artery Disease. 23:91-97 |
| ISSN: | 0954-6928 |
| DOI: | 10.1097/mca.0b013e32834f1165 |
| Popis: | Objective 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). Materials and methods 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. Results 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. Conclusion 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. |
| Databáze: | OpenAIRE |
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