N-terminal pro-brain natriuretic peptide on admission has prognostic value across the whole spectrum of acute coronary syndromes

• Published in: Circulation (New York, N.Y.) Vol. 110; no. 2; pp. 128 - 134
• Main Authors: Galvani, Marcello, Ottani, Filippo, Oltrona, Luigi, Ardissino, Diego, Gensini, Gian Franco, Maggioni, Aldo P, Mannucci, Pier Mannuccio, Mininni, Nicola, Prando, Maria Domenica, Tubaro, Marco, Vernocchi, Arialdo, Vecchio, Carlo
• Format: Journal Article
• Language: English
• Published: United States 13.07.2004
• Subjects: Acute Disease; Aged; Biomarkers; Coronary Disease - blood; Coronary Disease - complications; Coronary Disease - mortality; Electrocardiography; Female; Heart Failure - classification; Heart Failure - epidemiology; Heart Failure - etiology; Hospital Mortality; Humans; Life Tables; Male; Middle Aged; Natriuretic Peptide, Brain; Nerve Tissue Proteins - blood; Odds Ratio; Peptide Fragments - blood; Predictive Value of Tests; Prognosis; Risk; Risk Assessment; Risk Factors; ROC Curve; Treatment Outcome; Troponin T - blood
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.cir.0000134480.06723.d8

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. 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. 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.