title: B-type natriuretic peptide in the early diagnosis and risk stratification of acute chest pain.
abstract: BACKGROUND
  Myocardial ischemia is a strong trigger of B-type natriuretic peptide (BNP) release. As ischemia precedes necrosis in acute myocardial infarction, we hypothesized that BNP might be useful in the early diagnosis and risk stratification of patients with acute chest pain.
  
  
  METHODS
  In a prospective, international multicenter study, BNP was measured in 1075 unselected patients with acute chest pain. The final diagnosis was adjudicated by 2 independent cardiologists. Patients were followed long term regarding mortality.
  
  
  RESULTS
  Acute myocardial infarction was the adjudicated final diagnosis in 168 patients (16%). BNP levels at presentation were significantly higher in acute myocardial infarction as compared with patients with other diagnoses (median 224 pg/mL vs. 56 pg/mL, P <.001). The diagnostic accuracy of BNP for the diagnosis of acute myocardial infarction as quantified by the area under the receiver operating characteristic curve (AUC) (0.74; 95% confidence interval [CI], 0.70-0.78) was lower compared with cardiac troponin T at presentation (AUC 0.88; 95% CI, 0.84-0.92; P <.001). Cumulative 24-month mortality rates were 0.5% in the first, 2.1% in the second, 7.0% in the third, and 22.9% in the fourth quartile of BNP (P <.001). BNP predicted all-cause mortality independently of and more accurately than cardiac troponin T: AUC 0.81 (95% CI, 0.76-0.86) versus AUC 0.70 (95% CI, 0.62-0.77; P <.001). Net reclassification improvement for BNP was 0.10 (P=.04), and integrated discrimination improvement 0.068 (P=.01).
  
  
  CONCLUSIONS
  BNP accurately predicts mortality in unselected patients with acute chest pain independently of and more accurately than cardiac troponin T, but does not seem to help in the early diagnosis of acute myocardial infarction.
authors.affiliation: Department of Internal Medicine, University Hospital, Basel, Switzerland.
authors.forename: Philip
authors.initials: P
authors.lastname: Haaf
authors.forename: Tobias
authors.initials: T
authors.lastname: Reichlin
authors.forename: Nils
authors.initials: N
authors.lastname: Corson
authors.forename: Raphael
authors.initials: R
authors.lastname: Twerenbold
authors.forename: Miriam
authors.initials: M
authors.lastname: Reiter
authors.forename: Stephan
authors.initials: S
authors.lastname: Steuer
authors.forename: Stefano
authors.initials: S
authors.lastname: Bassetti
authors.forename: Katrin
authors.initials: K
authors.lastname: Winkler
authors.forename: Claudia
authors.initials: C
authors.lastname: Stelzig
authors.forename: Corinna
authors.initials: C
authors.lastname: Heinisch
authors.forename: Beatrice
authors.initials: B
authors.lastname: Drexler
authors.forename: Heike
authors.initials: H
authors.lastname: Freidank
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis* / Q000401:mortality*; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000787:Angina Pectoris / Q000175:diagnosis; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000097:blood / Q000209:etiology*; D018572:Disease-Free Survival; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012307:Risk Factors; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; D020107:Troponin T; D020097:Natriuretic Peptide, Brain