Background: The aim of this study was to investigate the combined prognostic value of admission serum levels of N-terminal pro-B type natriuretic peptide (NT-proBNP), cardiac troponin I, uric acid (UA), and high sensitivity C-reactive protein (hs-CRP) on 6-month major adverse cardiac events (MACE) in patients with and without congestive heart failure (CHF) after acute myocardial infarction (AMI). Methods: Between November 2005 and February 2010, 1,804 patients (1,231 men; mean age = 64.3 ± 11.9 years-old) were followed up more than 6-month after their AMI and finally analyzed in this study. The 6-month MACEs were defined as death, MI, and revascularizations. Results: Overall, patients with CHF (Killip class II-IV) were present in 461 (25.6%). The 6-month MACEs were significantly higher in CHF patients compared with no-CHF patients (7.1% versus 26.7%, p <0.001). In no-CHF patients, the levels of log-transformed NT-proBNP (p<0.001) and hs-CRP (p<0.001) were significantly higher in patients with MACEs, whereas the levels of log-transformed NT-proBNP (p<0.001), hs-CRP (p<0.001), and UA (p<0.001) were significantly higher in patients with MACEs in CHF patients. In Cox proportional hazards model, elevated serum levels of NT-pro BNP (hazard ratio [HR] 1.422, 95% confidence interval [CI] 1.133-1.785, p =0.002) was the only independent predictor of 6-month MACE in CHF patients, whereas elevated serum levels of NT-pro BNP (HR 1.348, 95% CI 1.032-1.760, p =0.028) and UA (HR 1.181, 95% CI 1.028-1.357, p =0.018) were independent predictors of 6-month MACE after adjustment for confounding variables. When the patients were divided into 4 groups according to the number of elevated biomarkers (NT-proBNP, UA, hs-CRP) in CHF patients, there was a significant gradual increased risk of 6-month MACE with increasing in the number of elevated biomarkers (9.5%, 16.9%, 30.5% and 44.9% of patients with 0, 1, 2 and 3 elevated biomarkers respectively, p <0.001). In Cox proportional hazards model, patients with 2 (HR 2.932, 95% CI 1.149-7.485, p =0.024) and 3 (HR 4.153, 95% CI 1.506-11.452, p =0.006) elevated biomarkers had significantly higher 6-month MACEs compared with patients with 0 elevated biomarkers. Conclusion: Biomarkers are differently related to 6-months MACEs in post-MI patients. With increasing number of elevated biomarkers, the risk of 6-month MACEs increases gradually that implies treatment intensification, and closer follow-up, particularly in CHF patients.
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