Circulation. 2003;108:275-281
Published online before print July 7, 2003, doi: 10.1161/01.CIR.0000079170.10579.DC
Published online before print July 7, 2003, doi: 10.1161/01.CIR.0000079170.10579.DC
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(Circulation. 2003;108:275.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
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
From the Department of Medical Sciences, Cardiology (S.K.J., B.L., L.W.) and Clinical Chemistry (A.S., M.S., P.V.), University of Uppsala, Uppsala, Sweden; the Department of Medicine (P.A.), University of Alberta, Edmonton, Canada; Centocor (E.S.B.), Malvern, Pa; Duke University Clinical Research Institute (R.C.), Durham, NC; Cleveland Clinic of Medicine, Case Western Reserve University (E.J.T.), Cleveland, Ohio; and the Thoraxcenter (M.L.S.), Erasmus Medical Center Rotterdam, the Netherlands.
Correspondence to Stefan James, MD, PhD, Department of Cardiology, Thoraxcenter, Academic Hospital, 751 85 Uppsala, Sweden. E-mail stefan.james{at}thorax.uas.lul.se
Background— Biochemical markers are useful for prediction of cardiac events in patients with non–ST-segment-elevation acute coronary syndrome (ACS). The associations between N-terminal pro–brain natriuretic peptide (NT-proBNP) and other biochemical and clinical risk indicators, as well as their prognostic value concerning the individual end points of death and myocardial infarction (MI), were elucidated in a large cohort of ACS patients.
Methods and Results— NT-proBNP, troponin T, and C-reactive protein (CRP) were analyzed in blood samples obtained at a median of 9.5 hours from symptom onset in 6809 of 7800 ACS patients in the Global Utilization of Strategies To Open occluded arteries-IV (GUSTO-IV) trial. Levels of NT-proBNP were correlated independently with age, female gender, low body weight, diabetes, renal dysfunction, history of MI, heart failure, heart rate, ongoing myocardial damage, and time since onset of ischemia. Increasing quartiles of NT-proBNP were related to short- and long-term mortality that reached 1.8%, 3.9%, 7.7%, and 19.2%, (P<0.001), respectively, at 1 year. Levels of troponin T, CRP, heart rate, and creatinine clearance, in addition to ST-segment depression, were also correlated independently with 1-year mortality, but NT-proBNP was the marker with the strongest relation. In contrast, only troponin T, creatinine clearance, and ST-segment depression were independently related to future MI. The combination of NT-proBNP and creatinine clearance provided the best prediction, with a 1-year mortality of 25.7% with both markers in the top quartile vs 0.3% with both markers in the bottom quartile.
Conclusions— The use of NT-proBNP appears to add critical prognostic insight to the assessment of patients with ACS.
Key Words: angina • myocardial infarction • coronary disease • natriuretic peptides • mortality
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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]
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R. Jarai, N. Iordanova, R. Jarai, A. Raffetseder, W. Woloszczuk, M. Gyongyosi, G. Geyer, J. Wojta, and K. Huber Risk assessment in patients with unstable angina/non-ST-elevation myocardial infarction and normal N-terminal pro-brain natriuretic peptide levels by N-terminal pro-atrial natriuretic peptide Eur. Heart J., February 1, 2005; 26(3): 250 - 256. [Abstract] [Full Text] [PDF]
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R. Schnabel, H. J. Rupprecht, K. J. Lackner, E. Lubos, C. Bickel, J. Meyer, T. Munzel, F. Cambien, L. Tiret, S. Blankenberg, et al. Analysis of N-terminal-pro-brain natriuretic peptide and C-reactive protein for risk stratification in stable and unstable coronary artery disease: results from the AtheroGene study Eur. Heart J., February 1, 2005; 26(3): 241 - 249. [Abstract] [Full Text] [PDF]
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T. J. Gluckman, M. Sachdev, S. P. Schulman, and R. S. Blumenthal A Simplified Approach to the Management of Non-ST-Segment Elevation Acute Coronary Syndromes JAMA, January 19, 2005; 293(3): 349 - 357. [Abstract] [Full Text] [PDF]
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P. W. Armstrong and Y. Fu Assessing risk in FRISC Eur. Heart J., January 2, 2005; 26(2): 103 - 104. [Full Text] [PDF]
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L. M. Biasucci CDC/AHA Workshop on Markers of Inflammation and Cardiovascular Disease: Application to Clinical and Public Health Practice: Clinical Use of Inflammatory Markers in Patients With Cardiovascular Diseases: A Background Paper Circulation, December 21, 2004; 110(25): e560 - e567. [Abstract] [Full Text] [PDF]
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S. J. Cameron and G. B. Green Cardiac Biomarkers in Renal Disease: The Fog Is Slowly Lifting Clin. Chem., December 1, 2004; 50(12): 2233 - 2235. [Full Text] [PDF]
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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]
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C. M. Gibson, R. L. Dumaine, E. V. Gelfand, S. A. Murphy, D. A. Morrow, S. D. Wiviott, R. P. Giugliano, C. P. Cannon, E. M. Antman, E. Braunwald, et al. Association of glomerular filtration rate on presentation with subsequent mortality in non-ST-segment elevation acute coronary syndrome; observations in 13307 patients in five TIMI trials Eur. Heart J., November 2, 2004; 25(22): 1998 - 2005. [Abstract] [Full Text] [PDF]
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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]
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T. Jernberg, B. Lindahl, A. Siegbahn, B. Andren, G. Frostfeldt, B. Lagerqvist, M. Stridsberg, P. Venge, and L. Wallentin Reply J. Am. Coll. Cardiol., November 2, 2004; 44(9): 1933 - 1933. [Full Text] [PDF]
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T. Jernberg, B. Lindahl, S. James, A. Larsson, L.-O. Hansson, and L. Wallentin Cystatin C: A Novel Predictor of Outcome in Suspected or Confirmed Non-ST-Elevation Acute Coronary Syndrome Circulation, October 19, 2004; 110(16): 2342 - 2348. [Abstract] [Full Text] [PDF]
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P. Bettencourt, A. Azevedo, J. Pimenta, F. Frioes, S. Ferreira, and A. Ferreira N-Terminal-Pro-Brain Natriuretic Peptide Predicts Outcome After Hospital Discharge in Heart Failure Patients Circulation, October 12, 2004; 110(15): 2168 - 2174. [Abstract] [Full Text] [PDF]
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S. Suzuki, M. Yoshimura, M. Nakayama, Y. Mizuno, E. Harada, T. Ito, S. Nakamura, K. Abe, M. Yamamuro, T. Sakamoto, et al. Plasma Level of B-Type Natriuretic Peptide as a Prognostic Marker After Acute Myocardial Infarction: A Long-Term Follow-Up Analysis Circulation, September 14, 2004; 110(11): 1387 - 1391. [Abstract] [Full Text] [PDF]
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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]
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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]
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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]
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R Bugiardini Risk stratification in acute coronary syndrome: focus on unstable angina/non-ST segment elevation myocardial infarction Heart, July 1, 2004; 90(7): 729 - 731. [Abstract] [Full Text] [PDF]
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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]
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A. Bayes-Genis, M. Santalo-Bel, E. Zapico-Muniz, L. Lopez, C. Cotes, J. Bellido, R. Leta, P. Casan, and J. Ordonez-Llanos N-terminal probrain natriuretic peptide (NT-proBNP) in the emergency diagnosis and in-hospital monitoring of patients with dyspnoea and ventricular dysfunction Eur J Heart Fail, March 15, 2004; 6(3): 301 - 308. [Abstract] [Full Text] [PDF]
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T. Jernberg, S. James, B. Lindahl, M. Stridsberg, P. Venge, and L. Wallentin NT-proBNP in unstable coronary artery disease--experiences from the FAST, GUSTO IV and FRISC II trials Eur J Heart Fail, March 15, 2004; 6(3): 319 - 325. [Abstract] [Full Text] [PDF]
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