title: Evaluation of B-type natriuretic peptide for risk assessment in unstable angina/non-ST-elevation myocardial infarction: B-type natriuretic peptide and prognosis in TACTICS-TIMI 18.
abstract: OBJECTIVE
  This study was designed to evaluate B-type natriuretic peptide (BNP) for risk assessment and clinical decision making over a range of cut points, alone and with cardiac troponin I (cTnI), in patients with non-ST-elevation acute coronary syndromes (ACS).
  
  
  BACKGROUND
  B-type natriuretic peptide holds promise for risk stratification. Additional evidence regarding optimal decision limits, use in combination with troponin, and use in targeting therapy is needed before acceptance into clinical use for ACS.
  
  
  METHODS
  We evaluated BNP at baseline in 1,676 patients with non-ST-elevation ACS randomized to early invasive versus conservative management.
  
  
  RESULTS
  Patients with elevated BNP (>80 pg/ml; n = 320) were at higher risk of death at seven days (2.5% vs. 0.7%, p = 0.006) and six months (8.4% vs. 1.8%, p < 0.0001). The association between BNP and mortality at six months (adjusted odds ratio [OR] 3.3; 95% confidence interval [CI] 1.7 to 6.3) was independent of important clinical predictors, including cTnI and congestive heart failure (CHF). Patients with elevated BNP had a fivefold higher risk of developing new CHF by 30 days (5.9% vs. 1.0%, p < 0.0001). B-type natriuretic peptide added prognostic information to cTnI, discriminating patients at higher mortality risk among those with negative (OR 6.9; 95% CI 1.9 to 25.8) and positive (OR 4.1; 95% CI 1.9 to 9.0) baseline cTnI results. No difference was observed in the effect of invasive versus conservative management when stratified by baseline levels of BNP (p(interaction) > or = 0.6).
  
  
  CONCLUSIONS
  Elevated BNP (>80 pg/ml) at presentation identifies patients with non-ST-elevation ACS who are at higher risk of death and CHF and adds incremental information to cTnI. Additional work is needed to identify therapies that may reduce the risk associated with increased BNP.
authors.affiliation: Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts 02115, USA. dmorrow@partners.org
authors.forename: David A
authors.initials: DA
authors.lastname: Morrow
authors.forename: James A
authors.initials: JA
authors.lastname: de Lemos
authors.forename: Marc S
authors.initials: MS
authors.lastname: Sabatine
authors.forename: Sabina A
authors.initials: SA
authors.lastname: Murphy
authors.forename: Laura A
authors.initials: LA
authors.lastname: Demopoulos
authors.forename: Peter M
authors.initials: PM
authors.lastname: DiBattiste
authors.forename: Carolyn H
authors.initials: CH
authors.lastname: McCabe
authors.forename: C Michael
authors.initials: CM
authors.lastname: Gibson
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Cannon
authors.forename: Eugene
authors.initials: E
authors.lastname: Braunwald
mesh_terms: D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000097:blood* / Q000503:physiopathology / Q000628:therapy; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002316:Cardiotonic Agents / Q000097:blood*; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000503:physiopathology / Q000628:therapy; D020097:Natriuretic Peptide, Brain; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D018570:Risk Assessment
chemical_list: D015415:Biomarkers; D002316:Cardiotonic Agents; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor