Document Detail

N-terminal pro-brain natriuretic peptide and other risk markers for the separate prediction of mortality and subsequent myocardial infarction in patients with unstable coronary artery disease: a Global Utilization of Strategies To Open occluded arteries (GUSTO)-IV substudy.
MedLine Citation:
PMID:  12847065     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Biochemical markers are useful for prediction of cardiac events in patients with non-ST-segment-elevation acute coronary syndrome (ACS). The associations between N-terminal pro-brain natriuretic peptide (NT-proBNP) and other biochemical and clinical risk indicators, as well as their prognostic value concerning the individual end points of death and myocardial infarction (MI), were elucidated in a large cohort of ACS patients.
METHODS AND RESULTS: NT-proBNP, troponin T, and C-reactive protein (CRP) were analyzed in blood samples obtained at a median of 9.5 hours from symptom onset in 6809 of 7800 ACS patients in the Global Utilization of Strategies To Open occluded arteries-IV (GUSTO-IV) trial. Levels of NT-proBNP were correlated independently with age, female gender, low body weight, diabetes, renal dysfunction, history of MI, heart failure, heart rate, ongoing myocardial damage, and time since onset of ischemia. Increasing quartiles of NT-proBNP were related to short- and long-term mortality that reached 1.8%, 3.9%, 7.7%, and 19.2%, (P<0.001), respectively, at 1 year. Levels of troponin T, CRP, heart rate, and creatinine clearance, in addition to ST-segment depression, were also correlated independently with 1-year mortality, but NT-proBNP was the marker with the strongest relation. In contrast, only troponin T, creatinine clearance, and ST-segment depression were independently related to future MI. The combination of NT-proBNP and creatinine clearance provided the best prediction, with a 1-year mortality of 25.7% with both markers in the top quartile vs 0.3% with both markers in the bottom quartile.
CONCLUSIONS: The use of NT-proBNP appears to add critical prognostic insight to the assessment of patients with ACS.
Stefan K James; Bertil Lindahl; Agneta Siegbahn; Mats Stridsberg; Per Venge; Paul Armstrong; Elliot S Barnathan; Robert Califf; Eric J Topol; Maarten L Simoons; Lars Wallentin
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2003-07-07
Journal Detail:
Title:  Circulation     Volume:  108     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2003 Jul 
Date Detail:
Created Date:  2003-07-23     Completed Date:  2003-08-13     Revised Date:  2013-05-24    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  275-81     Citation Subset:  AIM; IM    
Department of Medical Sciences, Cardiology, University of Uppsala, Uppsala, Sweden.
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MeSH Terms
Antibodies, Monoclonal / therapeutic use
Anticoagulants / therapeutic use
Biological Markers / blood
C-Reactive Protein / analysis
Cohort Studies
Coronary Artery Disease / blood*,  complications,  diagnosis*,  mortality
Disease Progression
Double-Blind Method
Immunoglobulin Fab Fragments / therapeutic use
Middle Aged
Myocardial Infarction* / etiology
Natriuretic Peptide, Brain
Nerve Tissue Proteins / blood*
Peptide Fragments / blood*
Predictive Value of Tests
Risk Assessment
Survival Analysis
Troponin T / blood
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Anticoagulants; 0/Biological Markers; 0/Immunoglobulin Fab Fragments; 0/Nerve Tissue Proteins; 0/Peptide Fragments; 0/Troponin T; 0/pro-brain natriuretic peptide (1-76); 114471-18-0/Natriuretic Peptide, Brain; 9007-41-4/C-Reactive Protein; X85G7936GV/abciximab
Comment In:
Circulation. 2004 Feb 10;109(5):e31-2; author reply e31-2   [PMID:  14769693 ]
Circulation. 2003 Jul 22;108(3):250-2   [PMID:  12876133 ]
Circulation. 2003 Jul 22;108(3):e9004-5   [PMID:  12876139 ]

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