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 ,
Per Venge, MD, PhD and
Bertil Lindahl, MD, PhD*
* Department of Medical Sciences, Cardiology, University Hospital, Uppsala, Sweden
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.
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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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D. A. Morrow and E. Braunwald
Future of Biomarkers in Acute Coronary Syndromes: Moving Toward a Multimarker Strategy
Circulation,
July 22, 2003;
108(3):
250 - 252.
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S. K. James, B. Lindahl, A. Siegbahn, M. Stridsberg, P. Venge, P. Armstrong, E. S. Barnathan, R. Califf, E. J. Topol, M. L. Simoons, et al.
N-Terminal Pro-Brain Natriuretic Peptide and Other Risk Markers for the Separate Prediction of Mortality and Subsequent Myocardial Infarction in Patients With Unstable Coronary Artery Disease: A Global Utilization of Strategies To Open occluded arteries (GUSTO)-IV Substudy
Circulation,
July 22, 2003;
108(3):
275 - 281.
[Abstract]
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A. M. Richards, M. G. Nicholls, E. A. Espiner, J. G. Lainchbury, R. W. Troughton, J. Elliott, C. Frampton, J. Turner, I. G. Crozier, and T. G. Yandle
B-Type Natriuretic Peptides and Ejection Fraction for Prognosis After Myocardial Infarction
Circulation,
June 10, 2003;
107(22):
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[Abstract]
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H. Ruskoaho
Cardiac Hormones as Diagnostic Tools in Heart Failure
Endocr. Rev.,
June 1, 2003;
24(3):
341 - 356.
[Abstract]
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M. Herrmann, J. Scharhag, M. Miclea, A. Urhausen, W. Herrmann, and W. Kindermann
Post-Race Kinetics of Cardiac Troponin T and I and N-Terminal Pro-Brain Natriuretic Peptide in Marathon Runners
Clin. Chem.,
May 1, 2003;
49(5):
831 - 834.
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D. A. Morrow, J. A. de Lemos, M. S. Sabatine, S. A. Murphy, L. A. Demopoulos, P. M. DiBattiste, C. H. McCabe, C. M. Gibson, C. P. Cannon, and E. Braunwald
Evaluation of B-type natriuretic peptide for risk assessment in unstable Angina/Non-ST-elevation myocardial infarction: B-type natriuretic peptide and prognosis in TACTICS-TIMI 18
J. Am. Coll. Cardiol.,
April 16, 2003;
41(8):
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[Abstract]
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J. A. de Lemos and D. A. Morrow
Brain Natriuretic Peptide Measurement in Acute Coronary Syndromes: Ready for Clinical Application?
Circulation,
December 3, 2002;
106(23):
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