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. 2022 Feb 24:9:797297.
doi: 10.3389/fcvm.2022.797297. eCollection 2022.

Prognostic Value of N-Terminal Pro-B-Type Natriuretic Peptide and High-Sensitivity C-Reactive Protein in Patients With Previous Myocardial Infarction

Ye-Xuan Cao  1   2 , Sha Li  1 , Hui-Hui Liu  1 , Meng Zhang  1 , Yuan-Lin Guo  1 , Na-Qiong Wu  1 , Cheng-Gang Zhu  1 , Qian Dong  1 , Jing Sun  1 , Ke-Fei Dou  1 , Jian-Jun Li  1
Affiliations

Prognostic Value of N-Terminal Pro-B-Type Natriuretic Peptide and High-Sensitivity C-Reactive Protein in Patients With Previous Myocardial Infarction

Ye-Xuan Cao et al. Front Cardiovasc Med. .

Abstract

Background: Patients with previous myocardial infarction (MI) have a poor prognosis and stratification for recurrent major adverse cardiovascular events (MACE) among these patients is of considerable interest. N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hs-CRP) are considered to be potential cardiovascular risk factors, but less is known about their prognostic importance in post-MI patients. This study aimed to evaluate the prognostic value of NT-proBNP and hs-CRP alone or together in patients who reported a prior MI.

Methods: In this prospective study, we consecutively enrolled 3,306 post-MI patients to assess the recurrent MACE. The predictive values of NT-proBNP and hs-CRP alone and together were assessed by multivariable Cox regression using hazard ratios (HR) and 95% confidence intervals (CI).

Results: During the 4-year follow-up period, 335 patients developed recurrent MACE. Multivariate Cox regression analysis showed a significant correlation between NT-proBNP levels and MACE (HR: 2.99, 95%CI: 2.06-4.36, p < 0.001), hard endpoints (HR: 5.44, 95%CI: 2.99-9.90, p < 0.001), cardiac mortality (HR: 5.92, 95%CI: 2.34-14.96, p < 0.001) and all-cause mortality (HR: 5.03, 95%CI: 2.51-10.09, p < 0.001). However, hs-CRP was not an independent predictor after adjusting for NT-proBNP. When patients were divided into six groups by using tertiles values of NT-proBNP and median values of hsCRP, patients with high NT-proBNP/hs-CRP values were 3.27 times more likely to experience MACE than patients with low NT-proBNP/hs-CRP values. The addition of NT-proBNP and hs-CRP to a prognostic model revealed a significant improvement in C-statistic, net reclassification, and integrated discrimination.

Conclusions: Increased NT-proBNP levels were associated with long-term worse outcomes and the combination of NT-proBNP and hs-CRP has an incremental value in the further risk stratification of post-MI patients.

Keywords: NT-proBNP; cardiovascular events; hs-CRP; myocardial infarction; prognosis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier curve for cardiovascular events according to NT-proBNP levels. (A) MACE; (B) hard endpoint; (C) cardiovascular mortality; (D) all-cause mortality.
Figure 2
Figure 2
Relationship between cardiovascular markers and cardiovascular events in the follow-up period [left panel: (A,C,E,G)]. Kaplan-Meier curve for cardiovascular events based on the combinations of NT-proBNP and hs-CRP levels [right panel: (B,D,F,H)]. 1 indicates low NT-proBNP + low hs-CRP group, 2 indicates median NT-proBNP + low hs-CRP group, 3 indicates high NT-proBNP + low hs-CRP group, 4 indicates low NT-proBNP + high hs-CRP group, 5 indicates median NT-proBNP + high hs-CRP group, 6 indicates high NT-proBNP + high hs-CRP group. NT-proBNP, N-terminal pro-brain natriuretic peptide; hs-CRP, high-sensitivity C-reactive protein; MACE, major adverse cardiovascular events.
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