Risk assessment in patients with unstable angina/non-ST-elevation myocardial infarction and normal N-terminal pro-brain natriuretic peptide levels by N-terminal pro-atrial natriuretic peptide.
OBJECTIVE
To compare the accuracy of the N-terminal fragment of its pro-hormone (Nt-proBNP) and N-terminal pro-atrial natriuretic peptide (Nt-proANP) in the prediction of the 2 year mortality and to investigate whether additional measurement of Nt-proANP to troponin I (TnI) could improve risk assessment in the subgroups of patients with unstable coronary artery disease (UCAD) and normal Nt-proBNP.


RESULTS
Plasma levels of the TnI, Nt-proANP, and Nt-proBNP were determined in 120 consecutive patients with UCAD without ST-segment elevations and normal left ventricular function. In multivariable logistic regression analysis, TnI and Nt-proBNP were independent predictors of mortality (P=0.01 and P=0.02, respectively). However, in the group of patients with normal Nt-proBNP levels, only Nt-proANP and TnI were independently associated with mortality (P=0.007 and P=0.03, respectively). Accordingly, patients with elevated Nt-proANP levels in this group of patients had significantly higher mortality rate than patients with normal Nt-proANP levels (P=0.003).


CONCLUSIONS
Our results suggest that determination of Nt-proANP might improve risk assessment in patients with UCAD, especially when Nt-proBNP is in the normal range.
Jarai
Rudolf
R
Third Department of Medicine (Cardiology and Emergency Medicine), Wilhelminen Hospital Vienna, Montleartstrasse 37, A-1171 Vienna, Austria.
Iordanova
Nelly
N
Jarai
Robert
R
Raffetseder
Annamaria
A
Woloszczuk
Wolfgang
W
Gyöngyösi
Mariann
M
Geyer
Georg
G
Wojta
Johann
J
Huber
Kurt
K
D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000097:blood / Q000401:mortality*; D009320:Atrial Natriuretic Factor / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality; D020097:Natriuretic Peptide, Brain; D009419:Nerve Tissue Proteins / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011498:Protein Precursors / Q000097:blood*; D012044:Regression Analysis; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D019210:Troponin I / Q000097:blood
C099254:N-terminal proatrial natriuretic peptide; D009419:Nerve Tissue Proteins; D010446:Peptide Fragments; D011498:Protein Precursors; D019210:Troponin I; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor