Admission N-terminal pro-brain natriuretic peptide and its interaction with admission troponin T and ST segment resolution for early risk stratification in ST elevation myocardial infarction

Abstract

Objective: To assess the long term prognostic value of N-terminal pro-brain natriuretic peptide (NTproBNP) on admission and its prognostic interaction with both admission troponin T (TnT) concentrations and resolution of ST segment elevation in fibrinolytic treated ST elevation myocardial infarction (STEMI). Design and setting: Substudy of the ASSENT (assessment of the safety and efficacy of a new thrombolytic) -2 and ASSENT-PLUS trials. Patients: NT-proBNP and TnT concentrations were determined on admission in 782 patients. According to NT-proBNP concentrations, patients were divided into three groups: normal concentration (for patients ( 65 years, ( 184 ng/l and ( 268 ng/l and for those . 65 years, ( 269 ng/l and ( 391 ng/l in men and women, respectively); higher than normal but less than the median concentration (742 ng/l); and above the median concentration. For TnT, a cut off of 0.1 mg/l was used. Of the 782 patients, 456 had ST segment resolution (, 50% or > 50%) at 60 minutes calculated from ST monitoring. Main outcome measures: All cause one year mortality. Results: One year mortality increased stepwise according to increasing concentrations of NT-proBNP (3.4%, 6.5%, and 23.5%, respectively, p , 0.001). In receiver operating characteristic analysis, NTproBNP strongly trended to be associated more with mortality than TnT and time to 50% ST resolution (area under the curve 0.81, 95% confidence interval (CI) 0.72 to 0.9, 0.67, 95% CI 0.56 to 0.79, and 0.66, 95% CI 0.56 to 0.77, respectively). In a multivariable analysis adjusted for baseline risk factors and TnT, both raised NT-proBNP and ST resolution , 50% were independently associated with higher one year mortality, whereas raised TnT contributed independently only before information on ST resolution was added to the model. Conclusion: Admission NT-proBNP is a strong independent predictor of mortality and gives, together with 50% ST resolution at 60 minutes, important prognostic information even after adjustment for TnT and baseline characteristics in STEMI.

B-type natriuretic peptide: a strong predictor of early and late mortality in patients with acute chest pain without ST-segment elevation in the emergency department

“…BNP has been valued as a strong and independent prognostic marker in patients with all forms of ACS [11][12][13]16] even when measured upon hospital arrival [15,18,24]. Several studies have also shown that BNP levels rise immediately after spontaneous or stress-induced cardiac ischemia [9,10,15,17].…”

N-Terminal Pro-B-Type Natriuretic Peptide Level Is Depressed in Patients With Significant Coronary Artery Disease Who Have High Body Mass Index

“…Stimulus for their release is an increase in left ventricular wall stress. 1) Circulating levels of BNP and NT-proBNP are increased in heart failure, acute coronary syndrome, chronic coronary disease, and atrial fibrillation, 2) and are closely linked to prognosis, [3][4][5][6][7] angiographic procedural complications, 8) and electrophysiological properties in atrial fibrillation.…”

Analysis of Circulating Forms of proBNP and NT-proBNP in Patients with Severe Heart Failure

“…These markers are becoming increasingly accepted by clinicians and laboratorians for the exclusion of HF, a disease with a high morbidity that currently affects 5 ϫ 10 6 people in the US and 10 ϫ 10 6 people in Europe and shows a high prevalence (Ͼ10%) in the elderly population (2,3 ). Recent studies have also indicated that BNP and NTproBNP may be useful as markers in other clinical settings, such as risk assessment in patients with acute coronary syndromes (4,5 ); however, full assessment of several factors, such as the biological variation in BNP (6 -8 ), its limited cardiac specificity, the various circulating forms of proBNP, and the specification of BNP and NT-proBNP assays, will be required to avoid confusion regarding interpreting results for these markers in daily practice (9 ).…”