title: B-type natriuretic peptide blood levels identify patients with non-ST elevation acute coronary syndromes at high risk for complications during intravenous beta-blocker infusion.
abstract: BACKGROUND
  We hypothesized that measurement of B-type natriuretic peptide could identify patients with non-ST elevation acute coronary syndromes at high risk for complications during beta-blocker (esmolol) infusion.
  
  
  METHODS
  We reviewed the records of 340 consecutive patients admitted with a non-ST elevation acute coronary syndrome. Seventy three (47 males, aged 62 ± 14 years) received esmolol up to a maximum dose of 300 μg/ kg/min until the symptoms were relieved or an adverse event occurred.
  
  
  RESULTS
  The median infusion rate at steady state was 175 μg/kg/min (median infusion time 18 h). Infusion was halted in 14 patients. The frequency of drug discontinuation increased across admission BNP quartiles. BNP > 141 pg/ml at admission had a 95% predictive value for subsequent withdrawal of esmolol. The presence of BNP > 141 pg/ml in combination with systolic blood pressure < 130 mmHg and left ventricular ejection fraction < 50% identified a group of patients at high risk for drug interruption (interruption frequency = 83%, 95% CI: 55-95%).
  
  
  CONCLUSIONS
  In conclusion, BNP measurement in combination with systolic blood pressure and 2D echocardiography may identify patients with non-ST elevation acute coronary syndromes at high risk for adverse events during esmolol infusion.
authors.affiliation: Konstantopouleio General Hospital, Athens, Greece. nikosnik@otenet.gr
authors.forename: Nikolaos I
authors.initials: NI
authors.lastname: Nikolaou
authors.forename: Michalis J
authors.initials: MJ
authors.lastname: Koutouzis
authors.forename: Apostolos
authors.initials: A
authors.lastname: Christou
authors.forename: Georgios M
authors.initials: GM
authors.lastname: Fournarakis
authors.forename: Sotirios P
authors.initials: SP
authors.lastname: Patsilinakos
authors.forename: Amalia
authors.initials: A
authors.lastname: Rompola
authors.forename: Alan S
authors.initials: AS
authors.lastname: Maisel
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000188:drug therapy*; D058671:Adrenergic beta-1 Receptor Antagonists / Q000008:administration & dosage / Q000009:adverse effects*; D001145:Arrhythmias, Cardiac / Q000139:chemically induced / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D004334:Drug Administration Schedule; D004452:Echocardiography; D005260:Female; D006115:Greece; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D011412:Propanolamines / Q000008:administration & dosage / Q000009:adverse effects*; D012189:Retrospective Studies
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D015415:Biomarkers; D011412:Propanolamines; D020097:Natriuretic Peptide, Brain; C036604:esmolol