N-terminal pro-brain natriuretic peptide on admission has prognostic value across the whole spectrum of acute coronary syndromes

Marcello Galvani, Filippo Ottani, Luigi Oltrona, Diego Ardissino, Gian Franco Gensini, Aldo P. Maggioni, Pier Mannuccio Mannucci, Nicola Mininni, Maria Domenica Prando, Marco Tubaro, Arialdo Vernocchi, Carlo Vecchio

Research output: Contribution to journalArticlepeer-review

Abstract

Background - The prognostic value of natriuretic peptide elevations in patients with acute coronary syndromes (ACS) is still incompletely defined. We measured N-terminal pro-brain natriuretic peptide (NT-proBNP) on admission in patients with ACS and ECG evidence of myocardial ischemia. Methods and Results - The NT-proBNP was measured at a median time of 3 hours after symptom onset in 1756 patients. The outcome measure was death at 30 days, which occurred in 113 patients (6.4%). The median NT-proBNP level was 353 ng/L (107 to 1357 ng/L). Compared with the lowest quartile, patients in the second, third, and fourth quartiles had a relative risk of subsequent death of 2.94 (95% CI, 1.15 to 7.52), 5.32 (95% CI, 2.19 to 12.91), and 11.5 (95% CI, 4.90 to 26.87), respectively. The NT-proBNP was independently associated with death in a logistic regression model, which included clinical variables, ECG, and troponin T in patients either with (OR of highest versus lowest quartile, 7.0; 95% CI, 1.9 to 25.6) or without (OR of highest versus lowest quartile, 4.1; 95% CI, 1.1 to 14.6) persistent ST-segment elevation. NT-proBNP was also an independent predictor of severe heart failure. Conclusions - The measurement of NT-proBNP on admission improves the early risk stratification of patients with ACS, suggesting the need for the development of targeted therapeutic strategies.

Original languageEnglish
Pages (from-to)128-134
Number of pages7
JournalCirculation
Volume110
Issue number2
DOIs
Publication statusPublished - Jul 13 2004

Keywords

  • Myocardial infarction
  • Natriuretic peptides
  • Prognosis

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

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