Sex-specific mortality prediction by pro-C-type natriuretic peptide measurement in a prospective cohort of patients with ST-elevation myocardial infarction
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Sex-specific mortality prediction by pro-C-type natriuretic peptide measurement in a prospective cohort of patients with ST-elevation myocardial infarction. / Mark, Peter D.; Frydland, Martin; Helgestad, Ole Kristian Lerche; Holmvang, Lene; Møller, Jacob Eifer; Johansson, Pär Ingemar; Ostrowski, Sisse R.; Prickett, Timothy; Hassager, Christian; Goetze, Jens Peter.
I: BMJ Open, Bind 11, Nr. 9, 048312, 2021.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Sex-specific mortality prediction by pro-C-type natriuretic peptide measurement in a prospective cohort of patients with ST-elevation myocardial infarction
AU - Mark, Peter D.
AU - Frydland, Martin
AU - Helgestad, Ole Kristian Lerche
AU - Holmvang, Lene
AU - Møller, Jacob Eifer
AU - Johansson, Pär Ingemar
AU - Ostrowski, Sisse R.
AU - Prickett, Timothy
AU - Hassager, Christian
AU - Goetze, Jens Peter
PY - 2021
Y1 - 2021
N2 - Objective To determine the predictive value of pro-C-type natriuretic peptide (pro-CNP) measurement in plasma sampled on admission from patients presenting with ST-elevation myocardial infarction (STEMI). Design Prospective cohort study. Setting Two University Hospitals in Denmark. Participants 1760 consecutive patients (470 females and 1290 males) with confirmed STEMI. Main outcomes and measures The main outcome was all-cause mortality at 1 year after presentation and the primary measure was pro-CNP concentration in plasma at admission in all patients and longitudinal measurements in a consecutive subgroup of 287 patients. A reference population (n=688) defined cut-off values of increased pro-CNP concentrations. Results In all patients, an increased pro-CNP concentration was associated with a higher all-cause mortality after 1 year (HR 1.6, 95% CI 1.1 to 2.4, P-logrank=0.009) including an interaction of sex (p=0.03). In separate sex-stratified analyses, female patients showed increased all-cause mortality (HR1 year 2.6, 95% CI 1.5 to 4.6), P-logrank = the median value to be independently associated with increased risk of mortality in female patients within 1 year (HR per 1 pmol/L increase: 1.04, 95% CI 1.01 to 1.06, p=0.007). Moreover, we found indications of sex differences in pro-CNP concentrations over time (higher pro-CNP in males (4.4, 95% CI -0.28 to 9.1 pmol/L, p=0.07) and interaction of sex and time (p=0.13)), and that hypertension was independently associated with higher pro-CNP (4.5, 95% CI 0.6 to 8.4 pmol/L, p=0.03). Conclusions In female but not male patients presenting with STEMI, high concentrations of pro-CNP (>= median) at admission independently indicate a higher risk of all-cause mortality. The findings are remarkably specific for female patients, suggesting a different vascular phenotype beyond traditional measures of coronary artery flow compared with male patients.
AB - Objective To determine the predictive value of pro-C-type natriuretic peptide (pro-CNP) measurement in plasma sampled on admission from patients presenting with ST-elevation myocardial infarction (STEMI). Design Prospective cohort study. Setting Two University Hospitals in Denmark. Participants 1760 consecutive patients (470 females and 1290 males) with confirmed STEMI. Main outcomes and measures The main outcome was all-cause mortality at 1 year after presentation and the primary measure was pro-CNP concentration in plasma at admission in all patients and longitudinal measurements in a consecutive subgroup of 287 patients. A reference population (n=688) defined cut-off values of increased pro-CNP concentrations. Results In all patients, an increased pro-CNP concentration was associated with a higher all-cause mortality after 1 year (HR 1.6, 95% CI 1.1 to 2.4, P-logrank=0.009) including an interaction of sex (p=0.03). In separate sex-stratified analyses, female patients showed increased all-cause mortality (HR1 year 2.6, 95% CI 1.5 to 4.6), P-logrank = the median value to be independently associated with increased risk of mortality in female patients within 1 year (HR per 1 pmol/L increase: 1.04, 95% CI 1.01 to 1.06, p=0.007). Moreover, we found indications of sex differences in pro-CNP concentrations over time (higher pro-CNP in males (4.4, 95% CI -0.28 to 9.1 pmol/L, p=0.07) and interaction of sex and time (p=0.13)), and that hypertension was independently associated with higher pro-CNP (4.5, 95% CI 0.6 to 8.4 pmol/L, p=0.03). Conclusions In female but not male patients presenting with STEMI, high concentrations of pro-CNP (>= median) at admission independently indicate a higher risk of all-cause mortality. The findings are remarkably specific for female patients, suggesting a different vascular phenotype beyond traditional measures of coronary artery flow compared with male patients.
KW - natriuretic peptides
KW - C-type natriuretic peptide
KW - CNP
KW - ANP
KW - reference intervals
KW - myocardial infarction
KW - GENDER
KW - EXPRESSION
KW - IMPACT
KW - FORMS
KW - HEART
U2 - 10.1136/bmjopen-2020-048312
DO - 10.1136/bmjopen-2020-048312
M3 - Journal article
C2 - 34588247
VL - 11
JO - BMJ Open
JF - BMJ Open
SN - 2044-6055
IS - 9
M1 - 048312
ER -
ID: 286622943