Value Of N-terminal Pro-brain Natriuretic Peptide Combined With Total Coronary Artery Calcification Score In Evaluating The Risk Of Prognosis Among Elderly Patients With Stable Coronary Artery Disease

Objective:To investigate the value of N-terminal pro-brain natriuretic peptide(NT-pro BNP)combined with total coronary artery calcification score(TCS)in evaluating the risk of prognosis among elderly patients with Stable Coronary Artery Disease(SCAD).Methods:A total of 264 elderly patients with SCAD,who were under treatment in Department of Geriatric Cardiology,Provincial Hospital Affiliated to Anhui Medical University from March 2013 to January 2016 were selected in the study.According to whether there major adverse cardiovascular events(MACE)during the follow-up periold(2-34months)or not,the subjects were classified into non-MACE group(n=151)and MACE group(n=113).The German full-automatic immunoassay analyzer(Roche Elecsys2010)and Roche kit were applied to detect the plasma levels of NT-pro BNP;CT scan of coronary artery of the patients was performed by 64-row with128-slice computed tomography of American General Electric Company(GE),after data collection,send the scanned image to the work station and calculate TCS by built-in Smart score.With statistical analysis,the two indicators were combined to build integrated prediction model to achieve the valuation of MACE among elderly patients with SCAD.Results:There were no significant differences in gender,age,BMI,smoking history,history of hypertension,history of diabetes mellitus and dyslipidemia between the two groups(P>0.05).NT-pro BNP and TCS in MACE group were significantly higher than those in non-MACE group(P<0.05).Logistic regression model was constructed: Logit(P)=-2.602 + 0.001 NT-pro BNP+0.010 TCS,and the new combined index Logit(P)was obtained.The area under the curve(AUC)of receiver operating characteristic(ROC)of MACE occurring in elderly patients with SCAD predicted by new combined indicators was 0.891[95%CI(0.847,0.926),P < 0.01)],and the sensitive and specificity were 0.788 and 0.848 respectively;The AUC of ROC of MACE occurring in elderly patients with SCAD Predicted by NT-pro BNP was 0.770[95%CI(0.715,0.820),P<0.01],and the sensitivity and specificity were0.549 and0.808 respectively;The AUC of ROC of MACE occurring in elderly patients with SCAD predicted by TCS was 0.833[95%CI(0.782,0.876),P<0.01],and the sensitivity and specificity were 0.779 and 0.755 respectively.The AUC of MACE occurring in patients predicted by new combined indictors,NT-pro BNP and TCS were significantly different(Z= 4.83 and 2.63 Respectively,P<0.01);The AUC of MACE occurring in patients predicted by NT-pro BNP and TCS were not significantly(Z=1.56,P=0.12).Conclusion:The value of NT-pro BNP combined with TCS in evaluating the risk of prognosis among elderly patients with SCAD is better than that of any single indicator,and provides a more reliable method of early prediction of the poor prognosis among elderly patients with SCAD.