Prognostic value of N-terminal-pro-brain natriuretic peptide measurements in patients with acute coronary syndromes : cardiovascular topic
Cardiovascular journal of South Africa(2006)
Abstract
lIgBackground:l/Ig The aim of this study was to examine
the prognostic value of admission N-terminal-pro-brain
natriuretic peptide (NT-proBNP) measurements for the
outcome of adverse events, and to compare it with that of
cardiac troponin T in the assessment of risk in patients
with acute coronary syndrome (ACS) during the hospital
stay and at six months following hospital discharge.
lbrglIg Methods:l/Ig The study population consisted of 200 Asian
Indian patients admitted with a diagnosis of ACS to the
Coronary Care Unit at RK Khan Hospital, Durban, South
Africa. A reference group comprising 100 healthy Indian
individuals drawn from the same community and who did
not suffer from cardiovascular disease was also analysed.
lbrgResults:l/Ig The majority of patients presented with ST
segment elevation myocardial infarction (STEMI)
(71%), whereas 14.5% had non-ST segment elevation
MI (NSTEMI), and the remaining 14.5% had unstable
angina. Patients had multiple risk factors for coronary
heart disease (CHD) including hypertension (59%), hypercholesterolaemia
(59%), smoking (57%), diabetes mellitus
(51%), obesity (46%), and a strong family history of CHD
(55%). NT-proBNP levels were significantly increased in
patients with STEMI (p = 0.005) and NSTEMI (p = 0.002)
who developed adverse events during their hospital stay,
compared with those who did not. At the six-month followup,
although NT-proBNP levels were higher in patients
with STEMI and NSTEMI who developed adverse events,
these differences were not statistically significant. No differences
in troponin T levels were detected in patients
with STEMI and NSTEMI who developed adverse events,
compared to those who did not, either during the hospital
stay, or at six months after release. At hospital admission,
24% of patients with unstable angina who had elevated
NT-proBNP levels and normal troponin T concentrations
developed adverse events, compared to 38% at six months.
NT-proBNP levels in the reference group were comparable
with those reported in other populations.
lbrglIgConclusion:l/Ig This study demonstrated that elevation in
admission NT-proBNP levels is an important determinant
of acute and intermediate cardiac risk in patients with
ACS. NT-proBNP concentrations were superior to those
of troponin T as prognostic markers in both STEMI and
NSTEMI. In a low-risk group of patients with unstable
angina and negative troponin T concentrations, elevated
NT-proBNP levels constituted a risk for the development
of adverse cardiovascular events. Therefore, NT-proBNP
should be included in the risk assessment of ACS to provide
guidance for further therapeutic strategies.
MoreTranslated text
Key words
acute coronary syndromes,prognostic value,cardiovascular topic,n-terminal-pro-brain
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