Brain natriuretic peptide and other risk markers for outcome assessment in patients with non-ST-elevation coronary syndromes and preserved systolic function
Brain natriuretic peptide and other risk markers for outcome assessment in patients with non-ST-elevation coronary syndromes and preserved systolic function
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DOI：
10.1016/j.amjcard.2006.06.023
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发表时间：
2006-11-15
影响因子：
2.8
通讯作者：
Puccetti, Luca
中科院分区：
文献类型：
--
作者：
Palazzuoli, Alberto;Deckers, Jaap;Puccetti, Luca
一些新出现的心脏标志物构成了冠状动脉疾病患者的强有力的预测因子。特别是，脑钠肽（BNP）、肌钙蛋白T（TnT）和C反应蛋白（CRP）与复发性缺血事件和死亡的风险增加有关。然而，人们对这些生物标志物的组合效用知之甚少。本研究对心脏收缩功能正常的冠心病患者进行了风险评估。我们连续研究了208例稳定型心绞痛、不稳定型心绞痛和非Q波心肌梗死患者（男性138例，女性70例），在入院时测量了他们的血浆BNP、TnT和CRP水平。所有入选患者均行超声心动图检查和选择性冠状动脉造影。在调整了临床表现、年龄、性别和常见危险因素后，BNP被证明是心力衰竭的一个强有力的预测因子（6个月，比值比[OR] 2.03，95%置信区间[CII 1.24至2.9，p < 0.01; 12个月，OR 2.65，95% CI 1.69至3.5，p < 0.001）和3、6和12个月时的死亡率（p < 0.001）。BNP水平与冠状动脉病变程度、左前降支受累程度相关（P < 0.01）。3组中BNP水平> 80 pg/mI的患者预后明显较差，心力衰竭和死亡的发生率增加。CRP与复发性缺血事件有关（梗死或复发性心绞痛，OR 1.4，95% CI 1.14至2.08，p < 0.01），与12个月时的主要心脏血运重建有关（OR 1.51，95% CI 1.29至1.73，p < 0.001）。TnT与12个月时复发性梗死或心绞痛轻度相关（OR 1.1，95% CI 0.96 ~ 1.22，p < 0.05），但与多支冠状动脉疾病相关（OR 1.47，95% CI 1.05 ~ 1.99，p < 0.01）。总之，BNP似乎与明显轻度风险患者的死亡率和心力衰竭风险长期增加相关。BNP还与更大范围和更严重的心肌缺血相关。在无左室功能不全或扩大的受试者中，早期BNP测定可为TnT和CRP提供增量信息，可能是最强的独立预测心脏结局的指标。(c)2006年爱思唯尔公司All rights reserved.
Several emerging cardiac markers constitute strong predictors among patients with coronary artery disease. In particular, brain natriuretic peptide (BNP), troponin T (TnT), and C-reactive protein (CRP) are related to increased risk of recurrent ischernic events and death. However, little is known about the utility of these biomarkers in combination. This study examined risk assessment in patients with coronary artery disease and preserved systolic function. We studied 208 consecutive patients (138 men, 70 women) with stable angina, unstable angina, and non-Q-wave myocardial infarction whose plasma BNP, TnT, and CRP levels were measured at hospital admission. All recruited patients underwent echocardiographic examination, and selective coronary angiography was performed. After adjusting for clinical presentation, age, gender, and common risk factors, BNP was demonstrated as a strong predictor of heart failure (6 months, odds ratio [OR] 2.03, 95% confidence interval [CII 1.24 to 2.9, p < 0.01; 12 months, OR 2.65, 95% CI 1.69 to 3.5, p < 0.001) and mortality at 3, 6, and 12 months (p < 0.001). BNP was also significantly related to extent of coronary artery disease and left anterior descending artery involvement (p < 0.01). Patients with a BNP level > 80 pg/mI in all 3 groups had a significantly poorer prognosis with increased incidence of heart failure and death. CRP was related to recurrent ischemic events (infarct or recurrent angina, OR 1.4, 95% CI 1.14 to 2.08, p < 0.01) and was associated with major' cardiac revascularization at 12 months (OR 1.51, 95% CI 1.29 to 1.73, p < 0.001). TnT demonstrated a mild correlation with recurrent infarct or angina at 12 months (OR 1.1, 95% CI 0.96 to 1.22, p < 0.05) but appeared related to multivessel coronary artery disease (OR 1.47, 95% CI 1.05 to 1.99, p < 0.01). In conclusion, BNP appears to be associated with a long-term increased risk of mortality and heart failure in patients with apparently mild risk. BNP is also associated with a larger extent and greater severity of myocardial ischemia. Early BNP measurement could provide incremental information to TnT and CRP, and it may be the strongest independent predictor of cardiac outcome in subjects without left ventricular dysfunction or enlargement. (c) 2006 Elsevier Inc. All rights reserved.