Abstract 20252: A Single Blood Drawing and one Question - Efficient Cardiovascular Risk Stratification by Determination of NT-pro-BNP Serum Levels and Chest Pain History in Primary Care
Introduction: The prognosis of chest pain is well established in patients with coronary artery disease, but still ill defined in primary prevention. Increasing evidence suggests that NT-pro-BNP can be used as a diagnostic tool for risk stratification in patients without known coronary artery disease. Therefore, the aim of our analysis was to assess the prognostic value of different forms of reported chest pain in combination with a one-time measurement of NT-pro-BNP serum levels in patients free of coronary artery disease in primary care.
Methods: In a total of 5570 unselected subjects of each age class between 18 and 85 free of coronary artery disease within the 55.518 participants of the population-based cross-sectional DETECT study, we assessed chest pain history by a comprehensive questionnaire and measured serum NT-pro-BNP levels. Three types of chest pain, any chest pain, exertional chest pain and classical angina, were defined. MACE (death, myocardial infarction, revascularization procedures) were assessed during a 5 year follow-up period.
Results: All types of reported chest pain were associated with an approximately three-fold increased risk for the occurrence of a first MACE, in male as well as in female subjects. The one-time measurement of NT-pro-BNP had a similar predictive value for MACE as any form of reported chest pain. Testing the usefulness of adding chest pain history and NT-pro-BNP measurement to classical cardiovascular risk factors revealed the strongest reclassification potential for the combination of exercise-induced chest pain and NT-pro-BNP, with a net reclassification improvement of 55.96% (p<0.0001) in the male population and 47.75% (p=0.002) in the female population. Adding NT-pro-BNP and exertional chest pain to classical risk factors resulted in a C-statistics value of 0.865 documenting excellent predictive power for incident MACE.
Conclusions: In primary prevention, a single measurement of NT-pro-BNP combined with a single question on exertional chest pain substantially improves cardiovascular risk prediction and allows for risk reclassification of nearly every second subject compared to assessing classical cardiovascular risk factors alone.
- © 2010 by American Heart Association, Inc.