Comparison of N-terminal pro-B-natriuretic peptide, C-reactive protein, and creatinine clearance for prognosis in patients with known coronary heart disease

BACKGROUND: The purpose of this study was to investigate the prognostic role of N-terminal pro-B-natriuretic peptide (NT-proBNP) serum level compared with C-reactive protein (CRP) level and creatinine clearance (CrCl) for the subsequent risk of cardiovascular events in a large cohort of patients with stable coronary heart disease (CHD). METHODS: Serum concentrations of NT-proBNP and CRP and CrCl were measured at baseline in a cohort of 1051 patients aged 30 to 70 years with CHD. The Cox proportional hazards model was used to determine the prognostic value of NT-proBNP, CRP, and CrCl on a combined cardiovascular disease (CVD) end point (fatal and nonfatal myocardial infarction and stroke). RESULTS: During follow-up (mean of 48.7 months), 95 patients (9.0%) experienced a secondary CVD event. Patients in the top quartile of the NT-proBNP distribution at baseline had a hazard ratio (HR) of 3.34 (95% confidence interval CI], 1.74-6.45) for subsequent secondary CVD events compared with those in the bottom quartile (P for trend <.001) after controlling for age, sex, smoking status, history of diabetes mellitus, initial management of CHD, rehabilitation clinic, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and treatment with lipid-lowering drugs. For CRP, the corresponding HR was 1.76 (95% CI, 0.96-3.24) (P value for trend, .06). Patients with CrCl levels lower than 60 mL/min had an HR of 2.39 (95% CI, 1.06-5.40) compared with patients with a CrCl of 90 mL/min or higher (P for trend, .002). If all 3 markers were included simultaneously in 1 model, NT-proBNP still showed predictive ability for recurrent CVD events. CONCLUSION: N-terminal proBNP may be a clinically useful marker weeks after an acute coronary event and may provide complementary prognostic information to established risk determinants.