Published Online
on June 14, 2004

A more recent version of this article appeared on July 13, 2004

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Submitted on June 16, 2003
Revised on March 23, 2004
Accepted on March 24, 2004

N-Terminal Pro-Brain Natriuretic Peptide on Admission Has Prognostic Value Across the Whole Spectrum of Acute Coronary Syndromes

Marcello Galvani MD^*, Filippo Ottani MD, Luigi Oltrona MD, Diego Ardissino MD, Gian Franco Gensini MD, Aldo P. Maggioni MD, Pier Mannuccio Mannucci MD, Nicola Mininni MD, Maria Domenica Prando MD, Marco Tubaro MD, Arialdo Vernocchi PhD, Carlo Vecchio MD, on behalf of the Italian Working Group on Atherosclerosis, Thrombosis, and Vascular Biology and the Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO)

From the Ospedale G.B. Morgagni and Fondazione Sacco, Forlì (M.G., F.O.); Ospedale Niguarda, Milan (L.O.); Ospedale Maggiore, Parma (D.A.); University of Florence, Florence (G.F.G.); ANMCO Research Center, Florence (A.P.M.); IRCCS Ospedale Maggiore and University of Milan, Milan (P.M.M.); Ospedale Monaldi, Naples (N.M.); Ospedale Maggiore della Carità, Novara (M.D.P.); Ospedale S. Filippo Neri, Rome (M.T.); Ospedale G.B. Morgagni, Forlì (A.V.); and Ospedale Galliera, Genova (C.V.), Italy.

^* To whom correspondence should be addressed. E-mail: galvanim{at}tin.it.

Background--The prognostic value of natriuretic peptide elevations in patients with acute coronary syndromes (ACS) is still incompletely defined. We measured N-terminal pro-brain natriuretic peptide (NT-proBNP) on admission in patients with ACS and ECG evidence of myocardial ischemia.

Methods and Results--The NT-proBNP was measured at a median time of 3 hours after symptom onset in 1756 patients. The outcome measure was death at 30 days, which occurred in 113 patients (6.4%). The median NT-proBNP level was 353 ng/L (107 to 1357 ng/L). Compared with the lowest quartile, patients in the second, third, and fourth quartiles had a relative risk of subsequent death of 2.94 (95% CI, 1.15 to 7.52), 5.32 (95% CI, 2.19 to 12.91), and 11.5 (95% CI, 4.90 to 26.87), respectively. The NT-proBNP was independently associated with death in a logistic regression model, which included clinical variables, ECG, and troponin T in patients either with (OR of highest versus lowest quartile, 7.0; 95% CI, 1.9 to 25.6) or without (OR of highest versus lowest quartile, 4.1; 95% CI, 1.1 to 14.6) persistent ST-segment elevation. NT-proBNP was also an independent predictor of severe heart failure.

Conclusions--The measurement of NT-proBNP on admission improves the early risk stratification of patients with ACS, suggesting the need for the development of targeted therapeutic strategies.

Key words: natriuretic peptides • myocardial infarction • prognosis

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