title: B-type natriuretic peptide: a novel early blood marker of acute myocardial infarction in patients with chest pain and no ST-segment elevation.
abstract: OBJECTIVE
  This study was undertaken to determine the diagnostic value of admission B-type natriuretic peptide (BNP) for acute myocardial infarction (AMI) in patients with acute chest pain and no ST-segment elevation.
  
  
  RESULTS
  A prospective study with 631 consecutive patients was conducted in the emergency department. Non-ST elevation AMI was present in 72 patients and their median admission BNP level was significantly higher than in unstable angina and non-acute coronary syndrome patients. Sensitivity of admission BNP for AMI (cut-off value of 100 pg/mL) was significantly higher than creatine kinase-MB (CKMB) and troponin-I on admission (70.8 vs. 45.8 vs. 50.7%, respectively, P<0.0001) and specificity was 68.9%. Simultaneous use of these markers significantly improved sensitivity to 87.3% and the negative predictive value to 97.3%. In multiple logistic regression analysis, admission BNP was a significant independent predictor of AMI, even when CKMB and troponin-I were present in the model.
  
  
  CONCLUSIONS
  BNP is a useful adjunct to standard cardiac markers in patients presenting to the emergency department with chest pain and no ST-segment elevation, particularly if initial CKMB and/or troponin-I are non-diagnostic.
authors.affiliation: Clinica São Vicente, R. João Borges 204, Rio de Janeiro 22.451-100, Brazil. rbaasan@domain.com.br
authors.forename: Roberto
authors.initials: R
authors.lastname: Bassan
authors.forename: Alfredo
authors.initials: A
authors.lastname: Potsch
authors.forename: Alan
authors.initials: A
authors.lastname: Maisel
authors.forename: Bernardo
authors.initials: B
authors.lastname: Tura
authors.forename: Humberto
authors.initials: H
authors.lastname: Villacorta
authors.forename: Mônica Viegas
authors.initials: MV
authors.lastname: Nogueira
authors.forename: Augusta
authors.initials: A
authors.lastname: Campos
authors.forename: Roberto
authors.initials: R
authors.lastname: Gamarski
authors.forename: Antonio Cláudio
authors.initials: AC
authors.lastname: Masetto
authors.forename: Marco Aurélio
authors.initials: MA
authors.lastname: Moutinho
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000097:blood / Q000175:diagnosis; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000175:diagnosis*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D019210:Troponin I / Q000097:blood
chemical_list: D015415:Biomarkers; D019210:Troponin I; D020097:Natriuretic Peptide, Brain