Sex-specific mortality prediction by pro-C-type natriuretic peptide measurement in a prospective cohort of patients with ST-elevation myocardial infarction
Autor: | Ole Kristian Lerche Helgestad, Peter D Mark, Christian Hassager, Jens P. Goetze, Jacob E. Møller, Martin Frydland, Lene Holmvang, Sisse R Ostrowski, Pär I. Johansson, Timothy C. R. Prickett |
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Rok vydání: | 2021 |
Předmět: |
Male
EXPRESSION medicine.medical_specialty IMPACT medicine.drug_class Cardiovascular Medicine FORMS St elevation myocardial infarction Internal medicine Natriuretic Peptide Brain Natriuretic peptide medicine Humans Prospective Studies Myocardial infarction Prospective cohort study business.industry Natriuretic Peptide C-Type General Medicine Specific mortality Prognosis medicine.disease University hospital myocardial infarction Increased risk medicine.anatomical_structure reference intervals ST Elevation Myocardial Infarction Medicine CNP HEART Female GENDER natriuretic peptides business Biomarkers C-type natriuretic peptide ANP Artery |
Zdroj: | Mark, P D, Frydland, M, Helgestad, O K L, Holmvang, L, Møller, J E, Johansson, P I, Ostrowski, S R, Prickett, T, Hassager, C & Goetze, J P 2021, ' Sex-specific mortality prediction by pro-C-type natriuretic peptide measurement in a prospective cohort of patients with ST-elevation myocardial infarction ', BMJ Open, vol. 11, no. 9, 048312 . https://doi.org/10.1136/bmjopen-2020-048312 BMJ Open, Vol 11, Iss 9 (2021) BMJ Open Mark, P D, Frydland, M, Helgestad, O K L, Holmvang, L, Møller, J E, Johansson, P I, Ostrowski, S R, Prickett, T, Hassager, C & Goetze, J P 2021, ' Sex-specific mortality prediction by pro-C-type natriuretic peptide measurement in a prospective cohort of patients with ST-elevation myocardial infarction ', BMJ Open, vol. 11, no. 9, pp. e048312 . https://doi.org/10.1136/bmjopen-2020-048312 Mark, P D, Frydland, M, Helgestad, O K L, Holmvang, L, Møller, J E, Johansson, P I, Ostrowski, S R, Prickett, T, Hassager, C & Goetze, J P 2021, ' Sex-specific mortality prediction by pro-C-type natriuretic peptide measurement in a prospective cohort of patients with ST-elevation myocardial infarction ', BMJ Open, vol. 11, no. 9, e048312 . https://doi.org/10.1136/bmjopen-2020-048312 |
ISSN: | 2044-6055 |
Popis: | ObjectiveTo determine the predictive value of pro-C-type natriuretic peptide (pro-CNP) measurement in plasma sampled on admission from patients presenting with ST-elevation myocardial infarction (STEMI).DesignProspective cohort study.SettingTwo University Hospitals in Denmark.Participants1760 consecutive patients (470 females and 1290 males) with confirmed STEMI.Main outcomes and measuresThe main outcome was all-cause mortality at 1 year after presentation and the primary measure was pro-CNP concentration in plasma at admission in all patients and longitudinal measurements in a consecutive subgroup of 287 patients. A reference population (n=688) defined cut-off values of increased pro-CNP concentrations.ResultsIn all patients, an increased pro-CNP concentration was associated with a higher all-cause mortality after 1 year (HR 1.6, 95% CI 1.1 to 2.4, Plogrank=0.009) including an interaction of sex (p=0.03). In separate sex-stratified analyses, female patients showed increased all-cause mortality (HR1 year 2.6, 95% CI 1.5 to 4.6), Plogrank 1 year 1.1, 95% CI 0.7 to 1.9, Plogrank=0.66). After adjusting for potential risk factors, we found increased pro-CNP concentrations≥the median value to be independently associated with increased risk of mortality in female patients within 1 year (HR per 1 pmol/L increase: 1.04, 95% CI 1.01 to 1.06, p=0.007). Moreover, we found indications of sex differences in pro-CNP concentrations over time (higher pro-CNP in males (4.4, 95% CI −0.28 to 9.1 pmol/L, p=0.07) and interaction of sex and time (p=0.13)), and that hypertension was independently associated with higher pro-CNP (4.5, 95% CI 0.6 to 8.4 pmol/L, p=0.03).ConclusionsIn female but not male patients presenting with STEMI, high concentrations of pro-CNP (≥median) at admission independently indicate a higher risk of all-cause mortality. The findings are remarkably specific for female patients, suggesting a different vascular phenotype beyond traditional measures of coronary artery flow compared with male patients. |
Databáze: | OpenAIRE |
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