N-terminal prohormone B-type natriuretic peptide and cardiovascular risk in stable coronary artery disease: a meta-analysis of nine prospective studies.

To evaluate the prognostic value of N-terminal prohormone B-type natriuretic peptide (NT-proBNP) for patients with stable coronary artery disease, we searched for all published English-language articles indexed in MEDLINE and PubMed through July 2011. Nine independent, prospective, cohort studies that assessed the association between NT-proBNP value and long-term prognosis were identified. The interested endpoints of this meta-analysis were all-cause mortality and cardiovascular mortality and cardiovascular events. A general variance-based method was used to pool the hazard ratio (HR). In a comparison of individuals in the top quartile with those in the bottom quartile of baseline values of NT-proBNP, the combined adjusted HR was 2.74 (95% confidence interval [CI], 1.85-3.62). The combined HRs for the second and third quartiles compared with the first quartile were 1.33 (95% CI, 0.83-1.82) and 1.85 (95% CI, 1.23-2.48), respectively. In a subanalysis grouped by the median value, per 1 standard deviation increase or per 1000 pg/mL increase of NT-proBNP, the overall effect also showed that poor prognosis was significantly increased with the elevation of NT-proBNP (HR, 1.58; 95% CI, 1.16-2.01). Available prospective studies indicated strong associations between the circulating concentration of NT-proBNP and long-term prognosis in patients with stable coronary artery disease.

Diagnostic value of serum ischemia modified albumin in coronary artery disease / 中华全科医师杂志

Objective To assess value of serum level of ischemia modified albumin (IMA) in diagnosis for myocardial ischemia of coronary artery disease (CAD). Methods Seventy-two patients with clinically suspected myocardial ischemia of CAD admitted to The First People's Hospital of Hangzhou during November 2009 to May 2010 ready for undergoing coronary angiography, the gold standard for diagnosis of CAD, were randomly selected for the study. The patients were divided into CAD and non-CAD groups based on their coronary angiography. Serum level of IMA was determined with cobalt-albumin binding ( ACB) assay before coronary angiography, which served as diagnostic standard for CAD. Logistic regression analysis method was used to evaluate varied levels of IMA with area under the receiver operating characteristic curve (AUCROC) in diagnosis for myocardial ischemia of CAD. Results Mean level of IMA was (97 ±24) U/ml and (81 ±15) U/ml for CAD group (n =51) and non-CAD group (n =21), respectively. Sensitivity and specificity of a cut-off value of IMA 83.69 U/ml in diagnosis for myocardial ischemia of CAD was 80 percent and 57 percent, respectively, with a predictive value of a positive test 82 percent and that of a negative test 55 percent, respectively, from AUCROC. Logistic regression analysis demonstrated that both hypertension (P=0. 022, 6 = 1.421, OR=4. 141) and level of IMA (P=0.003, b= 1.780, OR=5.928) were independent predictors for CAD. Conclusions Sensitivity, specificity and predictive value of a positive test of the level of IMA are relatively high in diagnosis for myocardial ischemia of CAD, which is an independent predictor of it.