on July 7, 2003
Circulation. 2003
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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Submitted on February 18, 2003
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. * To whom correspondence should be addressed. 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.
Revised on April 22, 2003
Accepted on April 25, 2003
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
Stefan K. James MD, PhD*,
Key words: angina • myocardial infarction • coronary disease • natriuretic peptides • mortality
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Circulation 2003 108: 250-252.
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B. Verges, M. Zeller, J. Desgres, G. Dentan, Y. Laurent, L. Janin-Manificat, I. L'Huillier, G. Rioufol, J.-C. Beer, H. Makki, et al. High plasma N-terminal pro-brain natriuretic peptide level found in diabetic patients after myocardial infarction is associated with an increased risk of in-hospital mortality and cardiogenic shock Eur. Heart J., September 1, 2005; 26(17): 1734 - 1741. [Abstract] [Full Text] [PDF]
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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]
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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]
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J G F Cleland, A Torabi, and N K Khan Epidemiology and management of heart failure and left ventricular systolic dysfunction in the aftermath of a myocardial infarction Heart, May 1, 2005; 91(suppl_2): ii7 - ii13. [Abstract] [Full Text] [PDF]
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M. Schillinger Cardiovascular Risk Stratification in Older Patients: Role of Brain Natriuretic Peptide, C-Reactive Protein, and Urinary Albumin Levels JAMA, April 6, 2005; 293(13): 1667 - 1669. [Full Text] [PDF]
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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]
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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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