High-sensitivity troponin I and B-type natriuretic peptide biomarkers for prediction of cardiovascular events in patients with coronary artery disease with and without diabetes mellitus
Abstract Background High-sensitivity troponin I (hs-Tnl) and B-type natriuretic peptide (BNP) are promising prognostic markers for coronary artery disease (CAD). This prospective cohort study investigated whether a combination of these cardiac biomarkers with conventional risk factors would add incr...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-12-01
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| Series: | Cardiovascular Diabetology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12933-019-0974-2 |
| _version_ | 1818643340120293376 |
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| author | Yuen-Kwun Wong Chloe Y. Y. Cheung Clara S. Tang JoJo S. H. Hai Chi-Ho Lee Kui-Kai Lau Ka-Wing Au Bernard M. Y. Cheung Pak-Chung Sham Aimin Xu Karen S. L. Lam Hung-Fat Tse |
| author_facet | Yuen-Kwun Wong Chloe Y. Y. Cheung Clara S. Tang JoJo S. H. Hai Chi-Ho Lee Kui-Kai Lau Ka-Wing Au Bernard M. Y. Cheung Pak-Chung Sham Aimin Xu Karen S. L. Lam Hung-Fat Tse |
| author_sort | Yuen-Kwun Wong |
| collection | DOAJ |
| description | Abstract Background High-sensitivity troponin I (hs-Tnl) and B-type natriuretic peptide (BNP) are promising prognostic markers for coronary artery disease (CAD). This prospective cohort study investigated whether a combination of these cardiac biomarkers with conventional risk factors would add incremental value for the prediction of secondary major adverse cardiovascular events (MACEs) in patients with CAD, with and without type 2 diabetes mellitus (T2DM). Methods Baseline plasma level of hs-Tnl and BNP was measured in 2275 Chinese patients with stable CAD. Patients were monitored for new-onset of MACE over a median of 51 months. Cox proportional hazard model and area under the receiver operating characteristic curve (AUC) were used to assess the association of cardiac biomarkers with MACE and their predictive values in relationship with or without T2DM. Results During the follow up period 402 (18%) patients experienced a new-onset MACE with hs-Tnl and BNP level significantly higher than in those without MACE. In multivariable analyses, patients with elevated hs-Tnl (hazard ratio, 1.75 [95% CI 1.41–2.17]; P < 0.001) and BNP (hazard ratio, 1.42 [95% CI 1.15–1.75]; P = 0.001) were significantly associated with an increased risk of MACE after adjustment for variables of a risk factor model of age, sex, T2DM and hypertension. The risk factor model had an AUC of 0.64 for MACE prediction. The AUC significantly increased to 0.68 by the addition of hs-Tnl to the risk factor model. Subgroup analyses showed that hs-Tnl and BNP remained significant predictors of MACE in both patients with and without T2DM in multivariable models with higher risk of MACE evident in those without T2DM. Among patients without T2DM, addition of each biomarker yielded greater predictive accuracy than in T2DM patients, with AUC further increased to 0.75 when a combination of hs-Tnl and BNP was added to the risk factor model (age, sex and hypertension). Conclusions Elevated hs-Tnl and BNP level are independent predictors of new-onset MACE in CAD patients, irrespective of diabetes status. Among CAD patients without T2DM, a combination of cardiac biomarkers hs-Tnl and BNP yield the greatest predictive value beyond conventional risk factors. |
| first_indexed | 2024-12-16T23:57:24Z |
| format | Article |
| id | doaj.art-fc6a8049ae44438aabf29871c72e76ba |
| institution | Directory Open Access Journal |
| issn | 1475-2840 |
| language | English |
| last_indexed | 2024-12-16T23:57:24Z |
| publishDate | 2019-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Diabetology |
| spelling | doaj.art-fc6a8049ae44438aabf29871c72e76ba2022-12-21T22:11:10ZengBMCCardiovascular Diabetology1475-28402019-12-0118111210.1186/s12933-019-0974-2High-sensitivity troponin I and B-type natriuretic peptide biomarkers for prediction of cardiovascular events in patients with coronary artery disease with and without diabetes mellitusYuen-Kwun Wong0Chloe Y. Y. Cheung1Clara S. Tang2JoJo S. H. Hai3Chi-Ho Lee4Kui-Kai Lau5Ka-Wing Au6Bernard M. Y. Cheung7Pak-Chung Sham8Aimin Xu9Karen S. L. Lam10Hung-Fat Tse11Department of Medicine, The University of Hong Kong, Queen Mary HospitalDepartment of Medicine, The University of Hong Kong, Queen Mary HospitalDepartment of Surgery, The University of Hong KongDepartment of Medicine, The University of Hong Kong, Queen Mary HospitalDepartment of Medicine, The University of Hong Kong, Queen Mary HospitalDepartment of Medicine, The University of Hong Kong, Queen Mary HospitalDepartment of Medicine, The University of Hong Kong, Queen Mary HospitalDepartment of Medicine, The University of Hong Kong, Queen Mary HospitalDepartment of Psychiatry, The University of Hong KongDepartment of Medicine, The University of Hong Kong, Queen Mary HospitalDepartment of Medicine, The University of Hong Kong, Queen Mary HospitalDepartment of Medicine, The University of Hong Kong, Queen Mary HospitalAbstract Background High-sensitivity troponin I (hs-Tnl) and B-type natriuretic peptide (BNP) are promising prognostic markers for coronary artery disease (CAD). This prospective cohort study investigated whether a combination of these cardiac biomarkers with conventional risk factors would add incremental value for the prediction of secondary major adverse cardiovascular events (MACEs) in patients with CAD, with and without type 2 diabetes mellitus (T2DM). Methods Baseline plasma level of hs-Tnl and BNP was measured in 2275 Chinese patients with stable CAD. Patients were monitored for new-onset of MACE over a median of 51 months. Cox proportional hazard model and area under the receiver operating characteristic curve (AUC) were used to assess the association of cardiac biomarkers with MACE and their predictive values in relationship with or without T2DM. Results During the follow up period 402 (18%) patients experienced a new-onset MACE with hs-Tnl and BNP level significantly higher than in those without MACE. In multivariable analyses, patients with elevated hs-Tnl (hazard ratio, 1.75 [95% CI 1.41–2.17]; P < 0.001) and BNP (hazard ratio, 1.42 [95% CI 1.15–1.75]; P = 0.001) were significantly associated with an increased risk of MACE after adjustment for variables of a risk factor model of age, sex, T2DM and hypertension. The risk factor model had an AUC of 0.64 for MACE prediction. The AUC significantly increased to 0.68 by the addition of hs-Tnl to the risk factor model. Subgroup analyses showed that hs-Tnl and BNP remained significant predictors of MACE in both patients with and without T2DM in multivariable models with higher risk of MACE evident in those without T2DM. Among patients without T2DM, addition of each biomarker yielded greater predictive accuracy than in T2DM patients, with AUC further increased to 0.75 when a combination of hs-Tnl and BNP was added to the risk factor model (age, sex and hypertension). Conclusions Elevated hs-Tnl and BNP level are independent predictors of new-onset MACE in CAD patients, irrespective of diabetes status. Among CAD patients without T2DM, a combination of cardiac biomarkers hs-Tnl and BNP yield the greatest predictive value beyond conventional risk factors.https://doi.org/10.1186/s12933-019-0974-2B-type natriuretic peptideCardiac troponinCoronary artery diseaseRisk predictionType 2 diabetes mellitus |
| spellingShingle | Yuen-Kwun Wong Chloe Y. Y. Cheung Clara S. Tang JoJo S. H. Hai Chi-Ho Lee Kui-Kai Lau Ka-Wing Au Bernard M. Y. Cheung Pak-Chung Sham Aimin Xu Karen S. L. Lam Hung-Fat Tse High-sensitivity troponin I and B-type natriuretic peptide biomarkers for prediction of cardiovascular events in patients with coronary artery disease with and without diabetes mellitus Cardiovascular Diabetology B-type natriuretic peptide Cardiac troponin Coronary artery disease Risk prediction Type 2 diabetes mellitus |
| title | High-sensitivity troponin I and B-type natriuretic peptide biomarkers for prediction of cardiovascular events in patients with coronary artery disease with and without diabetes mellitus |
| title_full | High-sensitivity troponin I and B-type natriuretic peptide biomarkers for prediction of cardiovascular events in patients with coronary artery disease with and without diabetes mellitus |
| title_fullStr | High-sensitivity troponin I and B-type natriuretic peptide biomarkers for prediction of cardiovascular events in patients with coronary artery disease with and without diabetes mellitus |
| title_full_unstemmed | High-sensitivity troponin I and B-type natriuretic peptide biomarkers for prediction of cardiovascular events in patients with coronary artery disease with and without diabetes mellitus |
| title_short | High-sensitivity troponin I and B-type natriuretic peptide biomarkers for prediction of cardiovascular events in patients with coronary artery disease with and without diabetes mellitus |
| title_sort | high sensitivity troponin i and b type natriuretic peptide biomarkers for prediction of cardiovascular events in patients with coronary artery disease with and without diabetes mellitus |
| topic | B-type natriuretic peptide Cardiac troponin Coronary artery disease Risk prediction Type 2 diabetes mellitus |
| url | https://doi.org/10.1186/s12933-019-0974-2 |
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