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Original Article
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Korean J Med. 2009;77(2):200-210.
- 급성 관동맥증후군에서 예후평가를 위한 NT-proBNP, troponin I, hs-CRP의 유용성
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오병천, 한승환, 정욱진, 강웅철, 서일혜, 엄영실, 문찬일, 봉정민, 신미승, 고광곤, 안태훈, 최인석, 신익균
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- The prognostic value of NT-proBNP, Troponin I, and hs-CRP in patients with acute coronary syndrome
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Pyung Chun Oh, Seung Hwan Han, Wook-Jin Chung, Woong Chol Kang, Yiel-Hea Seo, Young Sil Eom, Chan Il Moon, Jeong Min Bong, Mi Seung Shin, Kwang Kon Koh, Tae Hoon Ahn, In Suck Choi, Eak Kyun Shin
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- Abstract
- Background/Aims: Elevated levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), troponin I, and high-sensitivity
C-reactive protein (hs-CRP) are each associated with higher rates of death and recurrent myocardial ischemia in patients with acute
coronary syndrome (ACS). We evaluated the prognostic value of NT-proBNP and a multi-marker risk approach with the simultaneous
assessment of NT-proBNP, troponin I, and hs-CRP in patients with ACS.
Methods: We included 277 patients who were admitted for ACS between January and December 2006. We measured
NT-proBNP, troponin I, and hs-CRP within 24 hours of the onset of symptoms. Patients were followed for a median of 559 days for
cardiovascular events, including death, new myocardial infarction, heart failure, or rehospitalization for ACS.
Results: NT-proBNP was the most powerful predictor of clinical outcome among the biomarkers (HR 3.65, 95% CI 2.11-6.30),
followed by the peak troponin I and hs-CRP (HR 2.08, 95% CI 1.12-3.87; HR 1.99, 95% CI 1.18-3.37, respectively), but not the
baseline troponin I. A multi-marker risk approach with the simultaneous assessment of NT-proBNP, hs-CRP, and peak troponin I
was significantly associated with cardiovascular events, especially the presence of three positive biomarkers (adjusted HR 4.20,
95% CI 1.39-12.67).
Conclusions: NT-proBNP is the most powerful, independent predictor of clinical outcome among the cardiac biomarkers. Since
the peak troponin I level provides more prognostic information than the baseline level, follow-up measurement of troponin I may be
warranted for risk stratification. The multi-marker risk approach appears to have better prognostic performance than any marker in
isolation. (Korean J Med 77:200-210, 2009)
Keywords :Acute coronary syndrome, Prognosis, NT-proBNP, Troponin I, C-reactive protein
