| N-terminal pro-B-type natriuretic peptide levels for dynamic risk stratification of patients with acute coronary syndromes. | |
| | |
MedLine Citation:
|
PMID: 15533869 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: Elevated baseline levels of B-type natriuretic peptide (BNP) and the N-terminal fragments of its prohormone, N-terminal-pro-BNP (NT-proBNP), have been associated with adverse long-term outcome in patients with acute coronary syndromes, whereas the prognostic implications of serial NT-proBNP measurements have not been investigated to date. METHODS AND RESULTS: NT-proBNP, troponin T, and C-reactive protein were measured at baseline and at 48 and 72 hours in 1791 patients with non-ST-elevation acute coronary syndromes. Death and myocardial infarction were recorded during 30 days of follow-up. After adjustment for independent predictors of cardiac risk, baseline NT-proBNP levels >250 ng/L were associated with higher event rates (adjusted OR, 3.7; 95% CI, 2.3 to 5.7; P<0.001). In troponin T-negative patients, NT-proBNP identified a subgroup of high-risk patients (OR, 5.9; 95% CI, 2.6 to 13.3; P<0.001). The risk in those patients (7.2%) did not significantly differ from that in troponin T-positive patients (9.8%; P=0.25). Importantly, clinical stabilization without refractory ischemia was associated with a rapid (as soon as 48 hours after onset of symptoms) and significant (48 hours; -24%; 72 hours, -49%; both P<0.001) decline in NT-proBNP levels. In patients with high NT-proBNP baseline levels, lack of a rapid decline in NT-proBNP levels (< or =250 ng/L) was linked to an adverse short-term prognosis (OR, 33.7; 95% CI, 8.2 to 138.8; P<0.001). In patients with low NT-proBNP baseline levels, a rise in NT-proBNP levels over 72 hours to >250 ng/L was also linked to an adverse 30-day prognosis (OR, 24.0; 95% CI, 8.4 to 68.5; P<0.001). CONCLUSIONS: Neurohumoral activation as evidenced by NT-proBNP appears as a unifying feature that is independent of other biochemical markers (myocardial necrosis, inflammation) and is a powerful and independent determinant of the short-term cardiac risk in patients with acute coronary syndromes. Whether serial measurements of NT-proBNP in patients with ACS may be used to more rapidly identify patients suitable for early discharge or more intensive therapy deserves future prospective studies. |
| | |
Authors:
|
Christopher Heeschen; Christian W Hamm; Veselin Mitrovic; Nicte-Ha Lantelme; Harvey D White; |
Related Documents
:
|
15109419 - Patient data, early sars epidemic, taiwan. 21286009 - Clinical characteristics and etiology of travelers' diarrhea among korean travelers vis... 3122679 - Severe hypophosphatemia in hospitalized patients. 19046959 - Effect of renal replacement therapy on retinol-binding protein 4 isoforms. 7047589 - Bactericidal activity and chemotaxis in pemphigus vulgaris and bullous pemphigoid. 7629559 - Determination of plasma concentrations of amikacin in patients of an intensive care unit. 12003609 - Association between sleep apnea syndrome and nonarteritic anterior ischemic optic neuro... 16983929 - Relationship of peritoneal transport rate and dialysis adequacy with inflammation in pe... 6483519 - Radiologic manifestations of malabsorption: a nonspecific finding. |
Publication Detail:
|
Type: Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't Date: 2004-11-08 |
Journal Detail:
|
Title: Circulation Volume: 110 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2004 Nov |
Date Detail:
|
Created Date: 2004-11-16 Completed Date: 2005-06-15 Revised Date: 2006-11-15 |
Medline Journal Info:
|
Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
|
Languages: eng Pagination: 3206-12 Citation Subset: AIM; IM |
Affiliation:
|
J.W. Goethe University, Department of Cardiology, Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany. c.heeschen@em.uni-frankfurt.de |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Acute Disease Anticoagulants / administration & dosage, therapeutic use Aspirin / administration & dosage, therapeutic use Biological Markers C-Reactive Protein / analysis Drug Therapy, Combination Follow-Up Studies Heparin / administration & dosage, therapeutic use Humans Incidence Myocardial Infarction / mortality Myocardial Ischemia / blood*, classification, drug therapy, mortality Natriuretic Peptide, Brain Nerve Tissue Proteins / blood* Peptide Fragments / blood* Predictive Value of Tests Risk Risk Assessment Syndrome Troponin T / blood Tyrosine / administration & dosage, analogs & derivatives*, therapeutic use |
| Chemical | |
Reg. No./Substance:
|
0/Anticoagulants; 0/Biological Markers; 0/Nerve Tissue Proteins; 0/Peptide Fragments; 0/Troponin T; 0/pro-brain natriuretic peptide (1-76); 114471-18-0/Natriuretic Peptide, Brain; 144494-65-5/tirofiban; 50-78-2/Aspirin; 55520-40-6/Tyrosine; 9005-49-6/Heparin; 9007-41-4/C-Reactive Protein |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Right ventricular enlargement on chest computed tomography: a predictor of early death in acute pulm...
Next Document: Weight-loss-associated induction of peroxisome proliferator-activated receptor-alpha and peroxisome ...