A prospective cohort study of prognostic power of N-terminal probrain natriuretic peptide in patients with non-ST segment elevation acute coronary syndromes.
BACKGROUND
Braintype natriuretic peptide (BNP) or N-terminal segment of the prohormone (NT-proBNP) measured within the first few days after symptom onset offer prognostic information in patients with non- ST elevation acute coronary syndromes (ACS).


RESULTS
This prospective cohort study included 493 patients with non-ST segment elevation ACS who underwent percutaneous coronary intervention in the Deutsches Herzzentrum and Klinikum rechts der Isar in Munich, Germany. NT-proBNP was measured on admission. Patients were divided into four groups according to quartiles of NT-proBNP. The primary end point of the study was mortality. Patients were followed for a median of 4.0 years [interquartile range 3.6 to 4.9 years]. During this time period, there were 65 deaths: 4 deaths in the 1st quartile, 9 deaths in the 2nd quartile, 16 deaths in the 3rd quartile and 36 deaths in the 4th quartile (Kaplan-Meier estimates of mortality: 3.4, 7.8, 16.0 and 33.9%; odds ratio [OR] 10.2, 95% confidence interval [CI] 4.5 to 23.5; P< 0.001 for 4th vs 1st quartile). Patients in the upper quartile of NT-proBNP had a more adverse cardiovascular risk profile than patients in lower quartiles of NT-proBNP. After adjustment in the Cox proportional hazards model, the NT-proBNP remained an independent correlate of mortality (adjusted hazard ratio [HR] 1.23, 95% confidence interval [CI] 1.04 to 1.45, P = 0.014 for 4th vs 1st quartiles) but weaker than age (adjusted HR 2.11, 95% CI 1.53 to 2.90; P < 0.001 for a 10-year increase in age) or left ventricular ejection fraction (adjusted HR 1.35, 95% CI 1.09 to 1.68; P = 0.007 for a 10% decrease).


CONCLUSIONS
N-terminal probrain natriuretic peptide is a marker of weak-to-moderate strength in predicting the long-term prognosis in patients with non-ST segment elevation acute coronary syndromes after percutaneous coronary intervention.
Ndrepepa
Gjin
G
Deutsches Herzzentrum, Lazarettstrasse 36, 80636 München, Germany. ndrepepa@dhm.mhn.de
Braun
Siegmund
S
Mehilli
Julinda
J
Niemöller
Kathrin
K
Schömig
Albert
A
Kastrati
Adnan
A
D000368:Aged; D000789:Angina, Unstable / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers; D004562:Electrocardiography; D005260:Female; D005858:Germany; D006329:Heart Conduction System; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D013577:Syndrome
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain