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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

View larger version (15K): [in a new window]   Figure 1 Cumulative probability of death in patients with: 1) NT-proBNP 112 ng/l (n = 195); 2) NT-proBNP 113–400 ng/l (n = 193); 3) NT-proBNP 401–1,653 ng/l (n = 194); and 4) NT-proBNP 1,654 ng/l (n = 195). 1 vs. 2: log-rank p = 0.005; 2 vs. 3 and 3 vs. 4: log-rank p < 0.001. The curves are terminated when <10 patients remain at risk. NT-proBNP = N-terminal pro brain natriuretic peptide.

View larger version (26K): [in a new window]   Figure 2 Cumulative probability of death in patients with (A) acute myocardial infarction (n1–3 = 51, 57, 67) pooled log-rank p < 0.001; (B) angina or unstable angina (n1–4 = 50, 64, 74, 44) pooled log-rank p < 0.001; (C) other cardiac causes (n1–3 = 23, 23, 51) pooled log-rank p = 0.004; (D) other noncardiac or unknown causes (n1–4 = 124, 76, 40, 31) pooled log-rank p < 0.001. The curves are terminated when <10 patients remain at risk. NT-proBNP = N-terminal pro brain natriuretic peptide.

View larger version (21K): [in a new window]   Figure 3 Receiver operating characteristic curve concerning death at 35 months for NT-proBNP on admission, NT-proBNP at 6 h, and the relative change with an area under the curve (95% confidence interval) of 0.820 (0.784–0.856), 0.822 (0.786–0.857), and 0.554 (0.497–0.611), respectively. NT-proBNP = N-terminal pro brain natriuretic peptide.

View larger version (16K): [in a new window]   Figure 4 Positive predictive value concerning death at 35 months in relation to troponin T and NT-proBNP level on admission. Number of patients in each group is shown on each bar. NT-proBNP = N-terminal pro brain natriuretic peptide; cTnT = cardiac troponin T. Open bars = NT-proBNP < 401 ng/l; solid bars = NT-proBNP > 1,653 ng/l; hatched bars = NT-proBNP 401–1,653 ng/l.

View larger version (12K): [in a new window]   Figure 5 Positive predictive value concerning death at 35 months in relation to electrocardiogram and NT-proBNP level on admission. Number of patients in each group is shown on each bar. NT-proBNP = N-terminal pro brain natriuretic peptide; ECG = electrocardiogram; LBBB = left bundle branch block. Open bars = NT-proBNP < 400 ng/l; solid bars = NT-proBNP > 400 ng/l.