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J Am Coll Cardiol, 2002; 40:437-445
© 2002 by the American College of Cardiology Foundation
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CLINICAL STUDY

N-terminal pro brain natriuretic peptide on admission for early risk stratification of patients with chest pain and no ST-segment elevation

Tomas Jernberg, MD, PhD*,*, Mats Stridsberg, MD, PhD{dagger}, Per Venge, MD, PhD{dagger} and Bertil Lindahl, MD, PhD*

* Department of Medical Sciences, Cardiology, University Hospital, Uppsala, Sweden
{dagger} Department of Medical Sciences, Clinical Chemistry, University Hospital, Uppsala, Sweden

Manuscript received February 26, 2002; revised manuscript received April 8, 2002, accepted April 17, 2002.

* Reprint requests and correspondence: Dr. Tomas Jernberg, Department of Cardiology, Cardiothoracic Center, University Hospital, 751 85 Uppsala, Sweden.
tomas.jernberg{at}medsci.uu.se

OBJECTIVES: The study evaluated the prognostic value of single measurement of N-terminal pro brain natriuretic peptide (NT-proBNP) obtained on admission in patients with symptoms suggestive of an acute coronary syndrome and no ST-segment elevation.

BACKGROUND: Patients with symptoms suggestive of an acute coronary syndrome and no ST-segment elevation constitute a large and heterogeneous population. Early risk stratification has been based on clinical background factors, electrocardiography (ECG) and biochemical markers of myocardial damage. The neurohormonal activation has, so far, received less attention.

METHODS: The NT-proBNP was analyzed on admission in 755 patients admitted because of chest pain and no ST-segment elevation. Patients were followed concerning death for 40 months (median).

RESULTS: The median NT-proBNP level was 400 (111 to 1646) ng/l. Compared to the lowest quartile, patients in the second, third and fourth quartiles had a relative risk of subsequent death of 4.2 (1.6 to 11.1), 10.7 (4.2 to 26.8) and 26.6 (10.8 to 65.5), respectively. When NT-proBNP was added to a Cox regression model including clinical background factors, ECG and troponin T, the NT-proBNP levels were independently associated with prognosis.

CONCLUSIONS: A single measurement of NT-proBNP on admission will substantially improve the early risk stratification of patients with symptoms suggestive of an acute coronary syndrome and no ST-segment elevation. A combination of clinical background factors, ECG, troponin T and NT-proBNP obtained on admission will provide a highly discerning tool for risk stratification and further clinical decisions.

Abbreviations and Acronyms
  AMI
  acute myocardial infarction
  BNP
  brain natriuretic peptide
  CI
  confidence interval
  cTnT
  cardiac troponin T
  ECG
  electrocardiogram
  LBBB
  left bundle branch block
  LV
  left ventricular
  NT-proANP
  N-terminal pro atrial natriuretic peptide
  NT-proBNP
  N-terminal pro brain natriuretic peptide
  ROC
  receiver operating characteristic
  RR
  relative risk




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