N-Terminal Pro-Brain Natriuretic Peptide on Admission Has Prognostic Value Across the Whole Spectrum of Acute Coronary Syndromes.
Galvani, Marcello MD; Ottani, Filippo MD; Oltrona, Luigi MD; Ardissino, Diego MD; Gensini, Gian Franco MD; Maggioni, Aldo P. MD; Mannucci, Pier Mannuccio MD; Mininni, Nicola MD; Prando, Maria Domenica MD; Tubaro, Marco MD; Vernocchi, Arialdo PhD; Vecchio, Carlo MD; on behalf of the Italian Working Group on Atherosclerosis, Thrombosis and Vascular Biology and the Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO)
110(2):128-134, July 13, 2004.
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Background-: The prognostic value of natriuretic peptide elevations in patients with acute coronary syndromes (ACS) is still incompletely defined. We measured N-terminal pro-brain natriuretic peptide (NT-proBNP) on admission in patients with ACS and ECG evidence of myocardial ischemia.
Methods and Results-: The NT-proBNP was measured at a median time of 3 hours after symptom onset in 1756 patients. The outcome measure was death at 30 days, which occurred in 113 patients (6.4%). The median NT-proBNP level was 353 ng/L (107 to 1357 ng/L). Compared with the lowest quartile, patients in the second, third, and fourth quartiles had a relative risk of subsequent death of 2.94 (95% CI, 1.15 to 7.52), 5.32 (95% CI, 2.19 to 12.91), and 11.5 (95% CI, 4.90 to 26.87), respectively. The NT-proBNP was independently associated with death in a logistic regression model, which included clinical variables, ECG, and troponin T in patients either with (OR of highest versus lowest quartile, 7.0; 95% CI, 1.9 to 25.6) or without (OR of highest versus lowest quartile, 4.1; 95% CI, 1.1 to 14.6) persistent ST-segment elevation. NT-proBNP was also an independent predictor of severe heart failure.
Conclusions-: The measurement of NT-proBNP on admission improves the early risk stratification of patients with ACS, suggesting the need for the development of targeted therapeutic strategies.
(C) 2004 American Heart Association, Inc.