title: Very Long-Term Prognostic Role of Admission BNP in Non-ST Segment Elevation Acute Coronary Syndrome.
abstract: BACKGROUND
  BNP has been extensively evaluated to determine short- and intermediate-term prognosis in patients with acute coronary syndrome, but its role in long-term mortality is not known.
  
  
  OBJECTIVE
  To determine the very long-term prognostic role of B-type natriuretic peptide (BNP) for all-cause mortality in patients with non-ST segment elevation acute coronary syndrome (NSTEACS).
  
  
  METHODS
  A cohort of 224 consecutive patients with NSTEACS, prospectively seen in the Emergency Department, had BNP measured on arrival to establish prognosis, and underwent a median 9.34-year follow-up for all-cause mortality.
  
  
  RESULTS
  Unstable angina was diagnosed in 52.2%, and non-ST segment elevation myocardial infarction, in 47.8%. Median admission BNP was 81.9 pg/mL (IQ range = 22.2; 225) and mortality rate was correlated with increasing BNP quartiles: 14.3; 16.1; 48.2; and 73.2% (p < 0.0001). ROC curve disclosed 100 pg/mL as the best BNP cut-off value for mortality prediction (area under the curve = 0.789, 95% CI= 0.723-0.854), being a strong predictor of late mortality: BNP < 100 = 17.3% vs. BNP ≥ 100 = 65.0%, RR = 3.76 (95% CI = 2.49-5.63, p < 0.001). On logistic regression analysis, age >72 years (OR = 3.79, 95% CI = 1.62-8.86, p = 0.002), BNP ≥ 100 pg/mL (OR = 6.24, 95% CI = 2.95-13.23, p < 0.001) and estimated glomerular filtration rate (OR = 0.98, 95% CI = 0.97-0.99, p = 0.049) were independent late-mortality predictors.
  
  
  CONCLUSIONS
  BNP measured at hospital admission in patients with NSTEACS is a strong, independent predictor of very long-term all-cause mortality. This study allows raising the hypothesis that BNP should be measured in all patients with NSTEACS at the index event for long-term risk stratification.
authors: Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
authors: Fernando
authors: F
authors: Bassan
authors: Pontíficia Universidade Católica do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
authors: Roberto
authors: R
authors: Bassan
authors: Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
authors: Roberto
authors: R
authors: Esporcatte
authors: Departamento de Pesquisa Clínica, Instituto Nacional de Cardiologia, Rio de Janeiro, RJ, Brazil.
authors: Braulio
authors: B
authors: Santos
authors: Departamento de Pesquisa Clínica, Instituto Nacional de Cardiologia, Rio de Janeiro, RJ, Brazil.
authors: Bernardo
authors: B
authors: Tura
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000401:mortality*; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000097:blood / Q000175:diagnosis / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010343:Patient Admission / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain