1Universitätsklinikum Hamburg-Eppendorf Klinik für Kardiologie Hamburg, Deutschland; 2Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie Hamburg, Deutschland; 3Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie Hamburg, Deutschland; 4Universitätsklinikum Hamburg-Eppendorf Universitäres Herzzentrum Hamburg, Deutschland; 5Universitäres Herz- und Gefäßzentrum Hamburg Allgemeine und Interventionelle Kardiologie Hamburg, Deutschland
Background/Introduction: Individuals with atherosclerotic polyvascular disease (PVD) are at high risk for adverse events. Data about the association of cardiovascular biomarkers with outcomes in this high risk population is scarce. We therefore aimed to investigate the association of NT-proBNP and high-sensitivity Troponin T (hsTnT) concentrations with all-cause mortality stratified by the extent of atherosclerotic vascular disease (ASVD).
Methods: Between 2015 and 2020, patients undergoing coronary angiography were included in the prospective INTERCATH cohort. Individuals presenting with acute coronary syndromes, cardiac transplantation or missing biomarker concentrations were excluded for the current analysis. Subgroups of patients without prevalent ASVD, monovascular disease (MVD, i.e. ASVD either in the coronary, cerebral or lower leg arterial system), or PVD (ASVD in ≥2 arterial systems) were created. The Kaplan-Meier method was used to obtain a five-year mortality risk for each subgroup. Multivariable cox regression analyses were computed for the association of NT-proBNP and hsTnT with all-cause mortality adjusting for age, sex, arterial hypertension, body-mass-index, hyperlipoproteinemia, active smoking, diabetes mellitus and estimated glomerular filtration rate.
Results: Overall, 1,520 patients were included (median age 70.5 years, 27.9% women). N=279 had no prevalent ASVD whereas N=990 and N=251 suffered from MVD and PVD, respectively. Across these subgroups, a stepwise increase of NT-proBNP and hsTnT was observed according to the extent of ASVD (Table 1). During the median follow-up period of 4.35 years, a gradual increase of all-cause mortality was observed correlating to the extent of ASVD and with worst outcomes/cumulative event rates in PVD (Figure 1). Stratified for the extent of ASVD, hsTnT (no ASVD: HR 1.38 (95% CI: 1.04, 1.83); MVD: 1.40 (95% CI: 1.24, 1.59); PVD: 1.45 (95% CI: 1.19, 1.77)) and NT-proBNP (no ASVD: HR 1.59 (95% CI: 1.12, 2.25); MVD: HR 2.14 (95% CI: 1.81, 2.53); PVD: HR 1.94 (95% CI: 1.47, 2.55)) showed a significant association with all-cause mortality across all subgroups.
Conclusion: Patients with a greater extent of ASVD had higher concentration of cardiovascular biomarkers and an increased incidence of all-cause mortality. In multivariate adjusted analysis, NT-proBNP and hsTnT concentrations were reliably linked to all-cause mortality across the spectrum of ASVD extent, underscoring the role of biomarkers in risk prediction.
|
|
All (N=1,520) |
No ASVD (N=279) |
MVD (N=990) |
PVD (N=251) |
p-value |
|
Age (years) |
70.5 (61.5, 76.7) |
62.0 (55.0, 72.2) |
71.2 (62.6, 77.0) |
74.1 (65.8, 78.4) |
<0.001 |
|
Female No. (%) |
424 (27.9) |
112 (40.1) |
261 (26.4) |
51 (20.3) |
<0.001 |
|
NT-proBNP (ng/L) |
562.5 (179.8, 1994.5) |
405.0 (130.5, 1185.5) |
527.5 (175.2, 1908.2) |
1,086.0 (305.0, 3493.0) |
<0.001 |
|
hsTnT (ng/L) |
16.0 (9.0, 28.0) |
12.0 (7.0, 20.5) |
16.0 (9.0, 28.8) |
21.0 (12.0, 43.0) |
<0.001 |
Table 1: Baseline characteristics of the total study population and stratified according to the extent of atherosclerotic vascular disease (ASVD).