Abstract

Aim: Chest pain is a frequent reason to visit the emergency department. But not every patient needs longtime care. The aim of the current evaluation was to identify those, who shall profit of post-care, since they have the risk to die or to suffer from a major adverse cardiac event in the next years.

Methods: The longterm prognostic role of NTproBNP, IGFBP-7 and hsTNT was assessed in a cohort of 325 acute chest pain patients who visited the emergency department at the university hospital of Regensburg. After a median of 55 months, follow-up data regarding the end points all-cause mortality and major adverse cardiac events (MACE: mortality, congestive heart failure, acute coronary syndrome with the necessity of a coronary intervention, and stroke) was collected. 

Results: The majority of the cohort was male (70 %) and the median age was 62. Fifty-five patients died and 101 patients suffered from the combined end point during the follow-up. According to Kaplan-Meier analysis IGFBP-7, NTproBNP and hsTNT were all significant predictors for all-cause mortality and major adverse cardiac events (each p < 0.05). Regarding ROC analysis, the product of NTproBNP x IGFBP-7 (AUC exitus letalis/MACE 0.834/0.781) was significantly larger than NTproBNP (AUC exitus letalis/MACE 0.817/0.767; each p < 0.001), opposite to IGFBP-7 (AUC exitus letalis/MACE 0.839/0.802; each p=n.s.). Further, hsTNT had a significant lower AUC than all other markers (AUC exitus letalis/MACE 0.686/0.679; each p < 0.05). According to Cox regression analysis, NTproBNP, IGFBP-7 as well as NTproBNP x IGFBP-7 were independent predictors for mortality and the combined end point (each p < 0.05).

Conclusion: In a 55-month follow-up, IGFBP-7 showed a trend to a better prognostication than NTproBNP. Therefore, regarding IGFBP-7 further investigations shall be done to confirm a potential advantage.