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


* 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.
| ||||||||||||||||||||||||
This article has been cited by other articles:
![]() |
K. M. Eggers, T. Kempf, T. Allhoff, B. Lindahl, L. Wallentin, and K. C. Wollert Growth-differentiation factor-15 for early risk stratification in patients with acute chest pain Eur. Heart J., July 29, 2008; (2008) ehn339v1. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. J. West, P. J. Nestel, A. C. Kirby, R. Schnabel, D. Sullivan, R. J. Simes, C. Pollicino, E. Lubos, T. F. Munzel, H. D. White, et al. The value of N-terminal fragment of brain natriuretic peptide and tissue inhibitor of metalloproteinase-1 levels as predictors of cardiovascular outcome in the LIPID study Eur. Heart J., April 1, 2008; 29(7): 923 - 931. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. Weber, O. Bazzino, J. L. Navarro Estrada, J. J. Fuselli, F. Botto, D. Perez de Arenaza, H. Mollmann, H. N. Nef, A. Elsasser, and C. W. Hamm N-Terminal B-Type Natriuretic Peptide Assessment Provides Incremental Prognostic Information in Patients With Acute Coronary Syndromes and Normal Troponin T Values Upon Admission J. Am. Coll. Cardiol., March 25, 2008; 51(12): 1188 - 1195. [Abstract] [Full Text] [PDF] |
||||
![]() |
J Sanchis, X Bosch, V Bodi, N Bellera, J Nunez, B Benito, J Ordonez, L Consuegra, M Heras, and A Llecer Combination of clinical risk profile, early exercise testing and circulating biomarkers for evaluation of patients with acute chest pain without ST-segment deviation or troponin elevation Heart, March 1, 2008; 94(3): 311 - 315. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. L. Anderson, C. D. Adams, E. M. Antman, C. R. Bridges, R. M. Califf, D. E. Casey Jr, W. E. Chavey II, F. M. Fesmire, J. S. Hochman, T. N. Levin, et al. ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) Developed in Collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine J. Am. Coll. Cardiol., August 14, 2007; 50(7): e1 - e157. [Full Text] [PDF] |
||||
![]() |
Authors/Task Force Members, J.-P. Bassand, C. W. Hamm, D. Ardissino, E. Boersma, A. Budaj, F. Fernandez-Aviles, K. A.A. Fox, D. Hasdai, E. M. Ohman, et al. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology Eur. Heart J., July 1, 2007; 28(13): 1598 - 1660. [Full Text] [PDF] |
||||
![]() |
G. W. Moe, J. Howlett, J. L. Januzzi, H. Zowall, and for the Canadian Multicenter Improved Management o N-Terminal Pro-B-Type Natriuretic Peptide Testing Improves the Management of Patients With Suspected Acute Heart Failure: Primary Results of the Canadian Prospective Randomized Multicenter IMPROVE-CHF Study Circulation, June 19, 2007; 115(24): 3103 - 3110. [Abstract] [Full Text] [PDF] |
||||
![]() |
NACB WRITING GROUP MEMBERS, D. A. Morrow, C. P. Cannon, R. L. Jesse, L. K. Newby, J. Ravkilde, A. B. Storrow, A. H.B. Wu, and R. H. Christenson National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Clinical Characteristics and Utilization of Biochemical Markers in Acute Coronary Syndromes Circulation, April 3, 2007; 115(13): e356 - e375. [Full Text] [PDF] |
||||
![]() |
NACB WRITING GROUP MEMBERS, D. A. Morrow, C. P. Cannon, R. L. Jesse, L. K. Newby, J. Ravkilde, A. B. Storrow, A. H.B. Wu, R. H. Christenson, NACB COMMITTEE MEMBERS, et al. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Clinical Characteristics and Utilization of Biochemical Markers in Acute Coronary Syndromes Clin. Chem., April 1, 2007; 53(4): 552 - 574. [Full Text] [PDF] |
||||
![]() |
G. Kwan, S. R. Isakson, J. Beede, P. Clopton, A. S. Maisel, and R. L. Fitzgerald Short-Term Serial Sampling of Natriuretic Peptides in Patients Presenting With Chest Pain J. Am. Coll. Cardiol., March 20, 2007; 49(11): 1186 - 1192. [Abstract] [Full Text] [PDF] |
||||
![]() |
H. H H Feringa, O. Schouten, M. Dunkelgrun, J. J Bax, E. Boersma, A. Elhendy, R. de Jonge, S. E Karagiannis, R. Vidakovic, and D. Poldermans Plasma N-terminal pro-B-type natriuretic peptide as long-term prognostic marker after major vascular surgery Heart, February 1, 2007; 93(2): 226 - 231. [Abstract] [Full Text] [PDF] |
||||
![]() |
W. Koenig, D. Twardella, H. Brenner, and D. Rothenbacher Lipoprotein-Associated Phospholipase A2 Predicts Future Cardiovascular Events in Patients With Coronary Heart Disease Independently of Traditional Risk Factors, Markers of Inflammation, Renal Function, and Hemodynamic Stress Arterioscler. Thromb. Vasc. Biol., July 1, 2006; 26(7): 1586 - 1593. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. Weber and C. Hamm Role of B-type natriuretic peptide (BNP) and NT-proBNP in clinical routine. Heart, June 1, 2006; 92(6): 843 - 849. [Full Text] [PDF] |
||||
![]() |
J. A. Laukkanen, S. Kurl, M. Ala-Kopsala, O. Vuolteenaho, H. Ruskoaho, K. Nyyssonen, and J. T. Salonen Plasma N-terminal fragments of natriuretic propeptides predict the risk of cardiovascular events and mortality in middle-aged men Eur. Heart J., May 2, 2006; 27(10): 1230 - 1237. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. L. Januzzi Jr, R. Sakhuja, M. O'Donoghue, A. L. Baggish, S. Anwaruddin, C. U. Chae, R. Cameron, D. G. Krauser, R. Tung, C. A. Camargo Jr, et al. Utility of amino-terminal pro-brain natriuretic Peptide testing for prediction of 1-year mortality in patients with dyspnea treated in the emergency department. Arch Intern Med, February 13, 2006; 166(3): 315 - 320. [Abstract] [Full Text] [PDF] |
||||
![]() |
R. Schnabel, E. Lubos, H. J. Rupprecht, C. Espinola-Klein, C. Bickel, K. J. Lackner, F. Cambien, L. Tiret, T. Munzel, and S. Blankenberg B-Type Natriuretic Peptide and the Risk of Cardiovascular Events and Death in Patients With Stable Angina: Results From the AtheroGene Study J. Am. Coll. Cardiol., February 7, 2006; 47(3): 552 - 558. [Abstract] [Full Text] [PDF] |
||||
![]() |
R.L. Soiza, S.J. Leslie, P. Williamson, S. Wai, K. Harrild, N.R. Peden, and A.D. Hargreaves Risk stratification in acute coronary syndromes--does the TIMI risk score work in unselected cases? QJM, February 1, 2006; 99(2): 81 - 87. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. Richards, M. G. Nicholls, E. A. Espiner, J. G. Lainchbury, R. W. Troughton, J. Elliott, C. M. Frampton, I. G. Crozier, T. G. Yandle, R. Doughty, et al. Comparison of B-Type Natriuretic Peptides for Assessment of Cardiac Function and Prognosis in Stable Ischemic Heart Disease J. Am. Coll. Cardiol., January 3, 2006; 47(1): 52 - 60. [Abstract] [Full Text] [PDF] |
||||
![]() |
R. Talens-Visconti, M. Rivera Otero, M. J. Sancho-Tello, F. G. de Burgos, L. Martinez-Dolz, B. Sevilla, V. Climent, R. Cortes, A. Salvador, F. Sogorb, et al. Left ventricular cavity area reflects N-terminal pro-brain natriuretic peptide plasma levels in heart failure Eur J Echocardiogr, January 1, 2006; 7(1): 45 - 52. [Abstract] [Full Text] [PDF] |
||||
![]() |
D. A. Morrow, J. A. de Lemos, M. A. Blazing, M. S. Sabatine, S. A. Murphy, P. Jarolim, H. D. White, K. A. A. Fox, R. M. Califf, E. Braunwald, et al. Prognostic Value of Serial B-Type Natriuretic Peptide Testing During Follow-up of Patients With Unstable Coronary Artery Disease JAMA, December 14, 2005; 294(22): 2866 - 2871. [Abstract] [Full Text] [PDF] |
||||
![]() |
G. S. Ginsburg, M. P. Donahue, and L. K. Newby Prospects for Personalized Cardiovascular Medicine: The Impact of Genomics J. Am. Coll. Cardiol., November 1, 2005; 46(9): 1615 - 1627. [Abstract] [Full Text] [PDF] |
||||
![]() |
A. M. Mitchell, M. D. Brown, I. B.A. Menown, and J. A. Kline Novel Protein Markers of Acute Coronary Syndrome Complications in Low-Risk Outpatients: A Systematic Review of Potential Use in the Emergency Department Clin. Chem., November 1, 2005; 51(11): 2005 - 2012. [Abstract] [Full Text] [PDF] |
||||
![]() |
G. Ndrepepa, S. Braun, K. Niemoller, J. Mehilli, N. von Beckerath, O. von Beckerath, W. Vogt, A. Schomig, and A. Kastrati Prognostic Value of N-Terminal Pro-Brain Natriuretic Peptide in Patients With Chronic Stable Angina Circulation, October 4, 2005; 112(14): 2102 - 2107. [Abstract] [Full Text] [PDF] |
||||
![]() |
A.D. Struthers and J. Davies B-type natriuretic peptide: a simple new test to identify coronary artery disease? QJM, October 1, 2005; 98(10): 765 - 769. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. Mockel, R. Muller, J. O. Vollert, C. Muller, A. Carl, D. Peetz, F. Post, J. K. Kohse, and K. J. Lackner Role of N-Terminal Pro-B-Type Natriuretic Peptide in Risk Stratification in Patients Presenting in the Emergency Room Clin. Chem., September 1, 2005; 51(9): 1624 - 1631. [Abstract] [Full Text] [PDF] |
||||
![]() |
A. M. Richards and C. M. Frampton N-Terminal-Pro-B-Type Natriuretic Peptide: Universal Marker of Cardiovascular Risk? Circulation, July 5, 2005; 112(1): 9 - 11. [Full Text] [PDF] |
||||
![]() |
D. J. Campbell, M. Woodward, J. P. Chalmers, S. A. Colman, A. J. Jenkins, B. E. Kemp, B. C. Neal, A. Patel, and S. W. MacMahon Prediction of Myocardial Infarction by N-Terminal-Pro-B-Type Natriuretic Peptide, C-Reactive Protein, and Renin in Subjects With Cerebrovascular Disease Circulation, July 5, 2005; 112(1): 110 - 116. [Abstract] [Full Text] [PDF] |
||||
![]() |
A.M. Makikallio, T.H. Makikallio, J.T. Korpelainen, O. Vuolteenaho, J.M. Tapanainen, K. Ylitalo, K.A. Sotaniemi, H.V. Huikuri, and V.V. Myllyla Natriuretic Peptides and Mortality After Stroke Stroke, May 1, 2005; 36(5): 1016 - 1020. [Abstract] [Full Text] [PDF] |
||||
![]() |
C. Kragelund, B. Gronning, L. Kober, P. Hildebrandt, and R. Steffensen N-Terminal Pro-B-Type Natriuretic Peptide and Long-Term Mortality in Stable Coronary Heart Disease N. Engl. J. Med., February 17, 2005; 352(7): 666 - 675. [Abstract] [Full Text] [PDF] |
||||
![]() |
B. Lindahl, J. Lindback, T. Jernberg, N. Johnston, M. Stridsberg, P. Venge, and L. Wallentin Serial analyses of N-terminal pro-B-type natriuretic peptide in patients with non-ST-segment elevation acute coronary syndromes: A Fragmin and fast Revascularisation during InStability in coronary artery disease (FRISC)-II substudy J. Am. Coll. Cardiol., February 15, 2005; 45(4): 533 - 541. [Abstract] [Full Text] [PDF] |
||||
![]() |
R. M. Mills Warning! Context-sensitive data J. Am. Coll. Cardiol., February 15, 2005; 45(4): 542 - 543. [Full Text] [PDF] |
||||
![]() |
R. Bassan, A. Potsch, A. Maisel, B. Tura, H. Villacorta, M. V. Nogueira, A. Campos, R. Gamarski, A. C. Masetto, and M. A. Moutinho B-type natriuretic peptide: a novel early blood marker of acute myocardial infarction in patients with chest pain and no ST-segment elevation Eur. Heart J., February 1, 2005; 26(3): 234 - 240. [Abstract] [Full Text] [PDF] |
||||
![]() |
R. S. Foote, J. D. Pearlman, A. H. Siegel, and K.-T. J. Yeo Detection of exercise-induced ischemia by changes in B-type natriuretic peptides J. Am. Coll. Cardiol., November 16, 2004; 44(10): 1980 - 1987. [Abstract] [Full Text] [PDF] |
||||
![]() |
C. Heeschen, C. W. Hamm, V. Mitrovic, N.-H. Lantelme, H. D. White, and for the Platelet Receptor Inhibition in Ischemic S N-Terminal Pro-B-Type Natriuretic Peptide Levels for Dynamic Risk Stratification of Patients With Acute Coronary Syndromes Circulation, November 16, 2004; 110(20): 3206 - 3212. [Abstract] [Full Text] [PDF] |
||||
![]() |
R. Jarai, R. Jarai, and K. Huber N-terminal pro-brain natriuretic peptide in relation to inflammation, myocardial necrosis, and the effect of an invasive strategy in unstable coronary artery disease J. Am. Coll. Cardiol., November 2, 2004; 44(9): 1932 - 1932. [Full Text] [PDF] |
||||
![]() |
T. Jernberg, S. James, B. Lindahl, N. Johnston, M. Stridsberg, P. Venge, and L. Wallentin Natriuretic peptides in unstable coronary artery disease Eur. Heart J., September 1, 2004; 25(17): 1486 - 1493. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. Ala-Kopsala, J. Magga, K. Peuhkurinen, J. Leipala, H. Ruskoaho, J. Leppaluoto, and O. Vuolteenaho Molecular Heterogeneity Has a Major Impact on the Measurement of Circulating N-Terminal Fragments of A- and B-Type Natriuretic Peptides Clin. Chem., September 1, 2004; 50(9): 1576 - 1588. [Abstract] [Full Text] [PDF] |
||||
![]() |
S. Sadanandan, C. P. Cannon, K. Chekuri, S. A. Murphy, P. M. DiBattiste, D. A. Morrow, J. A. de Lemos, E. Braunwald, and C. M. Gibson Association of elevated B-type natriuretic peptide levels with angiographic findings among patients with unstable angina and non-ST-segment elevation myocardial infarction J. Am. Coll. Cardiol., August 4, 2004; 44(3): 564 - 568. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. Galvani, F. Ottani, L. Oltrona, D. Ardissino, G. F. Gensini, A. P. Maggioni, P. M. Mannucci, N. Mininni, M. D. Prando, M. Tubaro, et al. N-Terminal Pro-Brain Natriuretic Peptide on Admission Has Prognostic Value Across the Whole Spectrum of Acute Coronary Syndromes Circulation, July 13, 2004; 110(2): 128 - 134. [Abstract] [Full Text] [PDF] |
||||
![]() |
O. Bazzino, J. J Fuselli, F. Botto, D. Perez de Arenaza, C. Bahit, J. Dadone, and for the PACS group of investigators Relative value of N-terminal probrain natriuretic peptide, TIMI risk score, ACC/AHA prognostic classification and other risk markers in patients with non-ST-elevation acute coronary syndromes Eur. Heart J., May 2, 2004; 25(10): 859 - 866. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. P. Goetze, W. Yongzhong, J. F Rehfeld, E. Jorgensen, and J. Kastrup Coronary angiography transiently increases plasma pro-B-type natriuretic peptide Eur. Heart J., May 1, 2004; 25(9): 759 - 764. [Abstract] [Full Text] [PDF] |
||||
![]() |
A. Elsaesser and C. W. Hamm Acute Coronary Syndrome: The Risk of Being Female Circulation, February 10, 2004; 109(5): 565 - 567. [Full Text] [PDF] |
||||
![]() |
A. Clerico and M. Emdin Diagnostic Accuracy and Prognostic Relevance of the Measurement of Cardiac Natriuretic Peptides: A Review Clin. Chem., January 1, 2004; 50(1): 33 - 50. [Abstract] [Full Text] [PDF] |
||||
![]() |
T. Jernberg, B. Lindahl, A. Siegbahn, B. Andren, G. Frostfeldt, B. Lagerqvist, M. Stridsberg, P. Venge, and L. Wallentin N-terminal pro-brain natriuretic peptide in relation to inflammation, myocardial necrosis, and the effect of an invasive strategy in unstable coronary artery disease J. Am. Coll. Cardiol., December 3, 2003; 42(11): 1909 - 1916. [Abstract] [Full Text] [PDF] |
||||
![]() |
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. [Full Text] [PDF] |
||||
![]() |
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] [Full Text] [PDF] |
||||
![]() |
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): 2786 - 2792. [Abstract] [Full Text] [PDF] |
||||
![]() |
H. Ruskoaho Cardiac Hormones as Diagnostic Tools in Heart Failure Endocr. Rev., June 1, 2003; 24(3): 341 - 356. [Abstract] [Full Text] [PDF] |
||||
![]() |
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. [Full Text] [PDF] |
||||
![]() |
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): 1264 - 1272. [Abstract] [Full Text] [PDF] |
||||
![]() |
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): 2868 - 2870. [Full Text] [PDF] |
||||
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |