title: B-type natriuretic peptide as a predictor of anterior wall location in patients with non-ST-elevation myocardial infarction.
abstract: OBJECTIVE
  Involvement of the left ventricular anterior wall in ST-elevation myocardial infarction has a worse prognosis compared with other regions. In non-ST-elevation myocardial infarction, noninvasive methods of locating the ischemic myocardial territory have been limited. The objective of this report is therefore to determine what factors are predictive of the anterior location of the ischemic myocardial territory.
  
  
  METHODS
  This study included 170 patients with non-ST-elevation myocardial infarction. Clinical, echocardiographic, and laboratory characteristics, including B-type natriuretic peptide measured within 24 hours of hospitalization, and coronary angiographic features were analyzed.
  
  
  RESULTS
  The mean age was 64.5 ± 12.3 years, and 112 of the patients were male (66%). The median follow-up was 23 months. The territory involved, as determined from the angiogram, was divided into anterior [n = 80 (47%)] regions and inferior and lateral [n = 90 (53%)] regions. Multivariate analysis showed that B-type natriuretic peptide was the only independent predictor of an anterior wall infarct [OR = 3.70 (95% CI: 1.61 - 8.53); P = 0.002] in non-STelevation myocardial infarction patients. Multivariate analysis also showed that B-type natriuretic peptide was an independent predictor of in-hospital cardiac events during index admission [OR = 5.05 (95% CI: 1.49 - 17.12); P = 0.009] and of cardiac events occurring during follow-up [HR = 1.79 (95% CI: 1.05 - 3.04); P = 0.032].
  
  
  CONCLUSIONS
  B-type natriuretic peptide was the only factor independently associated with anterior wall involvement in non-ST-elevation myocardial infarction, and the peptide levels upon admission predicted in-hospital and subsequent cardiac events.
authors.affiliation: Heart Institute, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Rogério Bicudo
authors.initials: RB
authors.lastname: Ramos
authors.forename: Célia M
authors.initials: CM
authors.lastname: Strunz
authors.forename: Solange Desirée
authors.initials: SD
authors.lastname: Avakian
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Ramires
authors.forename: Antonio de Padua
authors.initials: Ade P
authors.lastname: Mansur
mesh_terms: D000368:Aged; D056988:Anterior Wall Myocardial Infarction / Q000097:blood* / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D001938:Brazil / Q000453:epidemiology; D017023:Coronary Angiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain