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

被引:149
|
作者
Galvani, M
Ottani, F
Oltrona, L
Ardissino, D
Gensini, GF
Maggioni, AP
Mannucci, PM
Mininni, N
Prando, MD
Tubaro, M
Vernocchi, A
Vecchio, C
机构
[1] Fdn Cardiol Sacco, I-47100 Forli, Italy
[2] Osped GB Morgagni, Forli, Italy
[3] Osped Niguarda Ca Granda, Milan, Italy
[4] Osped Maggiore Parma, Parma, Italy
[5] Univ Florence, Florence, Italy
[6] ANMCO Res Ctr, Florence, Italy
[7] Osped Maggiore, IRCCS, Milan, Italy
[8] Univ Milan, Milan, Italy
[9] Osped Monaldi, Naples, Italy
[10] Osped Maggiore della Carita, Novara, Italy
[11] Osped S Filippo Neri, Rome, Italy
[12] Osped Galliera, Genoa, Italy
关键词
natriuretic peptides; myocardial infarction; prognosis;
D O I
10.1161/01.CIR.0000134480.06723.D8
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页码:128 / 134
页数:7
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