Document Detail


Predictors of fatal and non-fatal outcomes in the Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA): incremental value of apolipoprotein A-1, high-sensitivity C-reactive peptide and N-terminal pro B-type natriuretic peptide.
MedLine Citation:
PMID:  19168876     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: Few prognostic models in heart failure have been developed in typically elderly patients treated with modern pharmacological therapy and even fewer included simple biochemical tests (such as creatinine), new biomarkers (such as natriuretic peptides), or, especially, both. In addition, most models have been developed for the single outcome of all-cause mortality.
METHODS AND RESULTS: We built a series of models for nine different fatal and non-fatal outcomes. For each outcome, a model was first built using demographic and clinical variables (Step 1), then with the addition of biochemical measures (serum creatinine, alanine aminotransferase, creatine kinase, thyrotrophin, apolipoproteins A-1 and B, and triglycerides) (Step 2) and finally with the incorporation of high-sensitivity C-reactive protein (hsCRP) and N-terminal pro B-type natriuretic peptide (NT-proBNP). Ranked according to the Wald chi(2) value, age (56), ejection fraction (44), and body mass index (42) were most predictive of all-cause mortality in Step 1 (total model chi(2) 343). Creatinine was the most powerful predictor at Step 2 (48) and ApoA-1 ranked fifth (25), with the overall chi(2) increasing to 440. Log NT-proBNP (167) was the most powerful of the 14 independently predictive variables identified at Step 3 and the overall chi(2) increased to 600. NT-proBNP was the most powerful predictor of each other outcome. hsCRP was not a predictor of all-cause mortality but did predict the composite atherothrombotic outcome.
CONCLUSION: Of the two new biomarkers studied in prognostic models in heart failure, NT-proBNP, but not hsCRP, added substantial and independent predictive information, for a range of clinical outcomes, to that provided by simple demographic, clinical, and biochemical measures. ApoA-1 was more predictive than LDL or HDL.
Authors:
Hans Wedel; John J V McMurray; Magnus Lindberg; John Wikstrand; John G F Cleland; Jan H Cornel; Peter Dunselman; Ake Hjalmarson; John Kjekshus; Michel Komajda; Timo Kuusi; Johan Vanhaecke; Finn Waagstein;
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2009-01-24
Journal Detail:
Title:  European journal of heart failure     Volume:  11     ISSN:  1388-9842     ISO Abbreviation:  Eur. J. Heart Fail.     Publication Date:  2009 Mar 
Date Detail:
Created Date:  2009-02-20     Completed Date:  2009-05-12     Revised Date:  2011-06-08    
Medline Journal Info:
Nlm Unique ID:  100887595     Medline TA:  Eur J Heart Fail     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  281-91     Citation Subset:  IM    
Affiliation:
Nordic School of Public Health, Göteborg, Sweden. hans.wedel@biostat.se
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MeSH Terms
Descriptor/Qualifier:
Administration, Oral
Aged
Apolipoprotein A-I / blood*
Biological Markers / blood
C-Reactive Protein / metabolism*
Cause of Death / trends
Dose-Response Relationship, Drug
Drug Administration Schedule
Female
Fluorobenzenes / administration & dosage,  therapeutic use*
Heart Failure / blood,  drug therapy,  mortality*
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage,  therapeutic use*
Male
Natriuretic Peptide, Brain / blood*
Nephelometry and Turbidimetry
Peptide Fragments / blood*
Prognosis
Protein Precursors
Pyrimidines / administration & dosage,  therapeutic use*
Risk Factors
Sulfonamides / administration & dosage,  therapeutic use*
Survival Rate / trends
Chemical
Reg. No./Substance:
0/Apolipoprotein A-I; 0/Biological Markers; 0/Fluorobenzenes; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors; 0/Peptide Fragments; 0/Protein Precursors; 0/Pyrimidines; 0/Sulfonamides; 0/pro-brain natriuretic peptide (1-76); 114471-18-0/Natriuretic Peptide, Brain; 287714-41-4/rosuvastatin; 9007-41-4/C-Reactive Protein
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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