Dynamic use of B-type natriuretic peptide-guided acute coronary syndrome therapy.
BACKGROUND
Very few studies have evaluated the potential of using B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) as surrogate markers to guide clinical interventional or conservative therapy decisions.


OBJECTIVE
: The aim of the current study was to evaluate the potential of using BNP and NT-proBNP as surrogate markers to guide clinical interventional or conservative therapy decisions.


METHODS
We identified randomized controlled trials that randomized patients with acute coronary syndrome (ACS) of unstable angina and myocardial infarction without ST-segment elevation ACS to early invasive therapy versus a more conservative approach by systematic search of articles and databases.


RESULTS
Five randomized controlled trials with a total of 8125 patients and with a mean duration of 11.2 months were included in the meta-analysis. At a mean follow-up of 11.2 months, the incidence of all-cause mortality was 5.9% in the early invasive group, compared with 6.8% in the conservative group (risk ratio = 0.74; 95% confidence interval, 0.59-0.86; P = 0.001).


CONCLUSIONS
In summary, BNP/NT-proBNP-guided management of ACS is significantly improved by early invasive therapy by improving long-term survival and reducing nonfatal myocardial infarction for unstable angina. However, there does not seem to be a clear benefit of using such a strategy over existing clinical recommendations.
International Medical Center (S-YD, JS, QZ), Chinese PLA General Hospital, Beijing, China; Hangzhou Sanatorium of Nanjing Military District (M-SD), Hangzhou, Zhejiang Province, China; Health Care Department (XY), Chinese PLA General Hospital, Beijing, China; Health Management Center (Z-HC), The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China.
Sheng-Yong
SY
Dong
Mao-Sheng
MS
Dong
Zhi-Heng
ZH
Chen
Jing
J
Sun
Xue
X
Yang
Qiang
Q
Zeng
D054058:Acute Coronary Syndrome / Q000097:blood* / Q000175:diagnosis / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D005500:Follow-Up Studies; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood; D016032:Randomized Controlled Trials as Topic / Q000379:methods
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain