B-type Natriuretic Peptide in the Early Diagnosis and Risk Stratification of Acute Chest Pain - 19/08/11
, Tobias Reichlin, MD a, , Nils Corson, MD a, Raphael Twerenbold, MD a, Miriam Reiter, MD a, Stephan Steuer, MD b, Stefano Bassetti, MD c, Katrin Winkler, MD d, e, Claudia Stelzig, MSc a, Corinna Heinisch, MD a, Beatrice Drexler, MD a, Heike Freidank, MD f, Christian Mueller, MD, FESC a, ⁎ 
Requests for reprints should be addressed to Christian Müller, MD, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, Basel CH-4031, SwitzerlandAbstract |
Background |
Myocardial ischemia is a strong trigger of B-type natriuretic peptide (BNP) release. As ischemia precedes necrosis in acute myocardial infarction, we hypothesized that BNP might be useful in the early diagnosis and risk stratification of patients with acute chest pain.
Methods |
In a prospective, international multicenter study, BNP was measured in 1075 unselected 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 168 patients (16%). BNP levels at presentation were significantly higher in acute myocardial infarction as compared with patients with other diagnoses (median 224 pg/mL vs. 56 pg/mL, P <.001). The diagnostic accuracy of BNP for the diagnosis of acute myocardial infarction as quantified by the area under the receiver operating characteristic curve (AUC) (0.74; 95% confidence interval [CI], 0.70-0.78) was lower compared with cardiac troponin T at presentation (AUC 0.88; 95% CI, 0.84-0.92; P <.001). Cumulative 24-month mortality rates were 0.5% in the first, 2.1% in the second, 7.0% in the third, and 22.9% in the fourth quartile of BNP (P <.001). BNP predicted all-cause mortality independently of and more accurately than cardiac troponin T: AUC 0.81 (95% CI, 0.76-0.86) versus AUC 0.70 (95% CI, 0.62-0.77; P <.001). Net reclassification improvement for BNP was 0.10 (P=.04), and integrated discrimination improvement 0.068 (P=.01).
Conclusions |
BNP accurately predicts mortality in unselected patients with acute chest pain independently of and more accurately than cardiac troponin T, but does not seem to help in the early diagnosis of acute myocardial infarction.
Le texte complet de cet article est disponible en PDF.Keywords : Acute Coronary Syndrome, Brain Natriuretic Peptide, Chest Pain, Diagnosis, Mortality
Plan
| Funding: The study was supported by research grants from the Swiss National Science Foundation (PP00B-102853), the Swiss Heart Foundation, Abbott, Roche, Siemens, and the Department of Internal Medicine, University Hospital Basel. |
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| Conflict of Interest: Dr. Mueller has received research support from the Swiss National Science Foundation (PP00B-102853), the Swiss Heart Foundation, the Novartis Foundation, the Krokus Foundation, Abbott, Astra Zeneca, Biosite, Brahms, Roche, Siemens, and the Department of Internal Medicine, University Hospital Basel, as well as speaker honoraria from Abbott, Biosite, Brahms, Roche, and Siemens. Dr. Reichlin has received research grants from the University of Basel and the Department of Internal Medicine, University Hospital Basel as well as speaker honoraria from Brahms and Roche. All other authors declare that they have no conflict of interest. |
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| Authorship: The authors designed the study, gathered and analyzed the data, vouch for the data and analysis, wrote the paper, and decided to publish. The sponsors had no role in designing or conducting the study and no role in gathering or analyzing the data or writing the manuscript. All authors had access to the data and a role in writing the manuscript. |
Vol 124 - N° 5
P. 444-452 - mai 2011 Retour au numéro
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