title: N-terminal pro B-type natriuretic peptide in the early evaluation of suspected acute myocardial infarction.
abstract: BACKGROUND
  Myocardial ischemia is a strong trigger of N-terminal pro-B-type natriuretic peptide (NT-proBNP) release. As ischemia precedes necrosis in acute myocardial infarction, we hypothesized that NT-proBNP might be useful in the early diagnosis and risk stratification of patients with suspected acute myocardial infarction.
  
  
  METHODS
  In a prospective multicenter study, NT-proBNP was measured at presentation in 658 consecutive 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 117 patients (18%). NT-proBNP levels at presentation were significantly higher in acute myocardial infarction as compared with patients with other final diagnoses (median 886 pg/mL vs 135 pg/mL, P <.001). The diagnostic accuracy of NT-proBNP for acute myocardial infarction as quantified by the area under the receiver operating characteristic curve (AUC) was 0.79 (95% confidence interval [CI], 0.75-0.83). When added to cardiac troponin T, NT-proBNP significantly increased the AUC from 0.89 (95% CI, 0.84-0.93) to 0.91 (95% CI, 0.88-0.94; P=.033). Cumulative 24-month mortality rates were 0% in the first, 1.3% in the second, 8.3% in the third, and 23.3% in the fourth quartile of NT-proBNP (P <.001). NT-proBNP (AUC 0.85, 95% CI, 0.81-0.89) predicted all-cause mortality independently of and more accurately than both cardiac troponin T (AUC 0.66, 95% CI, 0.58-0.74; P <.001) and the Thrombolysis in Myocardial Infarction risk score (AUC 0.79, 95% CI, 0.74-0.84; P <.001). Net reclassification improvement (Thrombolysis in Myocardial Infarction vs additionally NT-proBNP) was 0.188 (P <.009), and integrated discrimination improvement was 0.100 (P <.001).
  
  
  CONCLUSIONS
  Use of NT-proBNP improves the early diagnosis and risk stratification of patients with suspected acute myocardial infarction.
authors.affiliation: Department of Internal Medicine, University Hospital, Basel, Switzerland.
authors.forename: Philip
authors.initials: P
authors.lastname: Haaf
authors.forename: Cathrin
authors.initials: C
authors.lastname: Balmelli
authors.forename: Tobias
authors.initials: T
authors.lastname: Reichlin
authors.forename: Raphael
authors.initials: R
authors.lastname: Twerenbold
authors.forename: Miriam
authors.initials: M
authors.lastname: Reiter
authors.forename: Julia
authors.initials: J
authors.lastname: Meissner
authors.forename: Nora
authors.initials: N
authors.lastname: Schaub
authors.forename: Claudia
authors.initials: C
authors.lastname: Stelzig
authors.forename: Michael
authors.initials: M
authors.lastname: Freese
authors.forename: Patricia
authors.initials: P
authors.lastname: Paniz
authors.forename: Christophe
authors.initials: C
authors.lastname: Meune
authors.forename: Beatrice
authors.initials: B
authors.lastname: Drexler
authors.forename: Heike
authors.initials: H
authors.lastname: Freidank
authors.forename: Katrin
authors.initials: K
authors.lastname: Winkler
authors.forename: Willibald
authors.initials: W
authors.lastname: Hochholzer
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000097:blood*; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D015986:Confounding Factors, Epidemiologic; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016017:Odds Ratio; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain