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Biomolecules
Volume 10
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10.3390/biom10030394
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Article

Head-to-Head Comparison of the Incremental Predictive Value of The Three Established Risk Markers, Hs-troponin I, C-Reactive Protein, and NT-proBNP, in Coronary Artery Disease

by
Julius Nikorowitsch
1,
Francisco Ojeda
1,
Karl J. Lackner
2,3,
Renate B. Schnabel
1,4,
Stefan Blankenberg
1,4,
Tanja Zeller
1,4,† and
Mahir Karakas
1,4,*,†
1
Clinic of Cardiology, University Heart and Vascular Center, 20251 Hamburg, Germany
2
Department of Laboratory Medicine, University Medical Center, Johannes Gutenberg University, 55122 Mainz, Germany
3
German Center for Cardiovascular Research (DZHK), Partner Site Rhein-Main, 55131 Mainz, Germany
4
German Center for Cardiovascular Research (DZHK), Partner Site Hamburg, 23538 Lübeck, Kiel, Hamburg, Germany
*
Author to whom correspondence should be addressed.
†
Equal contribution.
Biomolecules 2020, 10(3), 394; https://doi.org/10.3390/biom10030394
Submission received: 27 January 2020 / Revised: 22 February 2020 / Accepted: 29 February 2020 / Published: 4 March 2020
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Abstract

Risk stratification among patients with coronary artery disease (CAD) is of considerable interest to potentially guide secondary preventive therapies. Cardiac troponins as well as C-reactive protein (hsCRP) and natriuretic peptides have emerged as biomarkers for risk stratification. The question remains if one of these biomarkers is superior in predicting adverse outcomes. Thus, we perform a head-to-head comparison between high-sensitivity troponin I (hsTnI), hsCRP, and N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with CAD. Plasma levels were measured in a cohort of 2193 patients with documented CAD. The main outcome measures were cardiovascular (CV) death and/or nonfatal myocardial infarction (MI). During a median follow-up of 3.8 years, all three biomarkers were associated with cardiovascular death and/or MI. After adjustments for conventional cardiovascular risk factors, the hazard ratio (HR) per standard deviation (SD) for the prediction of CV death and/or nonfatal MI was 1.39 [95% CI: 1.24–1.57, p < 0.001] for hsTnI, 1.41 [95% CI: 1.24–1.60, p < 0.001] for hsCRP, and 1.64 [95% CI: 1.39–1.92, p < 0.001] for NT-proBNP. However, upon further adjustments for the other two biomarkers, only NT-proBNP was still associated with the combined endpoint with an HR of 1.47 [95% CI: 1.19–1.82, p < 0.001]. Conclusively, NT-proBNP is reliably linked to CV death and MI in patients with CAD and provides incremental value beyond hsCRP and hsTnI.
Keywords: N-terminal pro-brain natriuretic peptide; high-sensitivity troponin I; high-sensitivity C-reactive protein; coronary artery disease; prognosis N-terminal pro-brain natriuretic peptide; high-sensitivity troponin I; high-sensitivity C-reactive protein; coronary artery disease; prognosis

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MDPI and ACS Style

Nikorowitsch, J.; Ojeda, F.; Lackner, K.J.; Schnabel, R.B.; Blankenberg, S.; Zeller, T.; Karakas, M. Head-to-Head Comparison of the Incremental Predictive Value of The Three Established Risk Markers, Hs-troponin I, C-Reactive Protein, and NT-proBNP, in Coronary Artery Disease. Biomolecules 2020, 10, 394. https://doi.org/10.3390/biom10030394

AMA Style

Nikorowitsch J, Ojeda F, Lackner KJ, Schnabel RB, Blankenberg S, Zeller T, Karakas M. Head-to-Head Comparison of the Incremental Predictive Value of The Three Established Risk Markers, Hs-troponin I, C-Reactive Protein, and NT-proBNP, in Coronary Artery Disease. Biomolecules. 2020; 10(3):394. https://doi.org/10.3390/biom10030394

Chicago/Turabian Style

Nikorowitsch, Julius, Francisco Ojeda, Karl J. Lackner, Renate B. Schnabel, Stefan Blankenberg, Tanja Zeller, and Mahir Karakas. 2020. "Head-to-Head Comparison of the Incremental Predictive Value of The Three Established Risk Markers, Hs-troponin I, C-Reactive Protein, and NT-proBNP, in Coronary Artery Disease" Biomolecules 10, no. 3: 394. https://doi.org/10.3390/biom10030394

APA Style

Nikorowitsch, J., Ojeda, F., Lackner, K. J., Schnabel, R. B., Blankenberg, S., Zeller, T., & Karakas, M. (2020). Head-to-Head Comparison of the Incremental Predictive Value of The Three Established Risk Markers, Hs-troponin I, C-Reactive Protein, and NT-proBNP, in Coronary Artery Disease. Biomolecules, 10(3), 394. https://doi.org/10.3390/biom10030394

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