title: N-terminal pro-brain natriuretic peptide on admission has prognostic value across the whole spectrum of acute coronary syndromes.
abstract: 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.
  
  
  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.
authors.affiliation: Ospedale G.B. Morgagni and Fondazione Sacco, Forlì, Italy. galvanim@tin.it
authors.forename: Marcello
authors.initials: M
authors.lastname: Galvani
authors.forename: Filippo
authors.initials: F
authors.lastname: Ottani
authors.forename: Luigi
authors.initials: L
authors.lastname: Oltrona
authors.forename: Diego
authors.initials: D
authors.lastname: Ardissino
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.forename: Pier Mannuccio
authors.initials: PM
authors.lastname: Mannucci
authors.forename: Nicola
authors.initials: N
authors.lastname: Mininni
authors.forename: Maria Domenica
authors.initials: MD
authors.lastname: Prando
authors.forename: Marco
authors.initials: M
authors.lastname: Tubaro
authors.forename: Arialdo
authors.initials: A
authors.lastname: Vernocchi
authors.forename: Carlo
authors.initials: C
authors.lastname: Vecchio
mesh_terms: D000208:Acute Disease; D000368:Aged; D015415:Biomarkers; D003327:Coronary Disease / Q000097:blood* / Q000150:complications / Q000401:mortality; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000145:classification / Q000453:epidemiology / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain; D009419:Nerve Tissue Proteins / Q000097:blood*; D016017:Odds Ratio; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012306:Risk; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; D009419:Nerve Tissue Proteins; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain