Document Detail

N-terminal pro B-type natriuretic peptide in the early evaluation of suspected acute myocardial infarction.
MedLine Citation:
PMID:  21787902     Owner:  NLM     Status:  MEDLINE    
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.
Philip Haaf; Cathrin Balmelli; Tobias Reichlin; Raphael Twerenbold; Miriam Reiter; Julia Meissner; Nora Schaub; Claudia Stelzig; Michael Freese; Patricia Paniz; Christophe Meune; Beatrice Drexler; Heike Freidank; Katrin Winkler; Willibald Hochholzer; Christian Mueller
Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of medicine     Volume:  124     ISSN:  1555-7162     ISO Abbreviation:  Am. J. Med.     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-07-26     Completed Date:  2011-09-14     Revised Date:  2012-04-30    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  731-9     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 Elsevier Inc. All rights reserved.
Department of Internal Medicine, University Hospital, Basel, Switzerland.
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MeSH Terms
Aged, 80 and over
Angina Pectoris / blood*
Area Under Curve
Biological Markers / blood
Confounding Factors (Epidemiology)
Early Diagnosis
International Cooperation
Middle Aged
Multivariate Analysis
Myocardial Infarction / blood*,  diagnosis*,  drug therapy,  mortality
Natriuretic Peptide, Brain / blood*
Odds Ratio
Peptide Fragments / blood*
Predictive Value of Tests
Prospective Studies
ROC Curve
Risk Assessment
Risk Factors
Thrombolytic Therapy
Treatment Outcome
Troponin T / blood
Reg. No./Substance:
0/Biological Markers; 0/Peptide Fragments; 0/Troponin T; 0/pro-brain natriuretic peptide (1-76); 114471-18-0/Natriuretic Peptide, Brain
Comment In:
Am J Med. 2012 Apr;125(4):e19; author reply e21   [PMID:  22444111 ]
Am J Med. 2011 Aug;124(8):677-8   [PMID:  21683327 ]

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