N-terminal pro-brain natriuretic peptide on admission has prognostic value across the whole spectrum of acute coronary syndromes.
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.
Galvani
Marcello
M
Ospedale G.B. Morgagni and Fondazione Sacco, Forlì, Italy. galvanim@tin.it
Ottani
Filippo
F
Oltrona
Luigi
L
Ardissino
Diego
D
Gensini
Gian Franco
GF
Maggioni
Aldo P
AP
Mannucci
Pier Mannuccio
PM
Mininni
Nicola
N
Prando
Maria Domenica
MD
Tubaro
Marco
M
Vernocchi
Arialdo
A
Vecchio
Carlo
C
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
D015415:Biomarkers; D009419:Nerve Tissue Proteins; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain