Published online before print June 14, 2004, doi: 10.1161/01.CIR.0000134480.06723.D8
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(Circulation. 2004;110:128-134.)
© 2004 American Heart Association, Inc.
Original Articles |
N-Terminal Pro-Brain Natriuretic Peptide on Admission Has Prognostic Value Across the Whole Spectrum of Acute Coronary Syndromes
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.
Correspondence to Marcello Galvani, MD, Fondazione Cardiologica Sacco, Piazza F.lli Ruffini, 6, 47100 Forlì, Italy. E-mail galvanim{at}tin.it
Received June 16, 2003; de novo received January 11, 2004; revision received March 23, 2004; accepted March 24, 2004.
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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